Healthcare Provider Details

I. General information

NPI: 1336719509
Provider Name (Legal Business Name): TAYLOR BAIRD M.A., LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 CANYON BLVD STE 300H
BOULDER CO
80302-4979
US

IV. Provider business mailing address

255 CANYON BLVD STE 300H
BOULDER CO
80302-4979
US

V. Phone/Fax

Practice location:
  • Phone: 720-819-7847
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0018507
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: