Healthcare Provider Details

I. General information

NPI: 1255973699
Provider Name (Legal Business Name): JANELLE MARIE TAYLOR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 10/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2632 E THOMAS RD # 100
PHOENIX AZ
85016-8220
US

IV. Provider business mailing address

2632 E THOMAS RD # 100
PHOENIX AZ
85016-8220
US

V. Phone/Fax

Practice location:
  • Phone: 602-957-2507
  • Fax: 602-957-2510
Mailing address:
  • Phone: 602-957-2507
  • Fax: 602-957-2510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-18096
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: