Healthcare Provider Details

I. General information

NPI: 1427653708
Provider Name (Legal Business Name): TAYLOR ROIG LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16620 N 40TH ST STE G1
PHOENIX AZ
85032-3351
US

IV. Provider business mailing address

16620 N 40TH ST STE G1
PHOENIX AZ
85032-3351
US

V. Phone/Fax

Practice location:
  • Phone: 602-363-0629
  • Fax: 480-247-4179
Mailing address:
  • Phone: 602-363-0629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: