Healthcare Provider Details

I. General information

NPI: 1689626368
Provider Name (Legal Business Name): MARY ELIZABETH TAYLOR MSW. LCSW, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. MARY ELIZABETH ANDREWS

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5350 TOMAH DR STE 3600
COLO SPGS CO
80918-6991
US

IV. Provider business mailing address

5350 TOMAH DR STE 3600
COLO SPGS CO
80918-6991
US

V. Phone/Fax

Practice location:
  • Phone: 719-251-9040
  • Fax:
Mailing address:
  • Phone: 719-251-9040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLAC #187
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number991143
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: