Healthcare Provider Details

I. General information

NPI: 1629789516
Provider Name (Legal Business Name): TAYLOR BAMFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 E 5TH ST
TUCSON AZ
85711-2005
US

IV. Provider business mailing address

4301 E 5TH ST
TUCSON AZ
85711-2005
US

V. Phone/Fax

Practice location:
  • Phone: 520-795-0300
  • Fax: 520-795-8206
Mailing address:
  • Phone: 520-795-0300
  • Fax: 520-795-8206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-23606
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: