Healthcare Provider Details

I. General information

NPI: 1790446839
Provider Name (Legal Business Name): MARCHELL DERONNE TAYLOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2021
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 E DICKENSON PL
DENVER CO
80222-6012
US

IV. Provider business mailing address

1882 E 104TH AVE UNIT 528
THORNTON CO
80233-4327
US

V. Phone/Fax

Practice location:
  • Phone: 303-504-6500
  • Fax: 303-757-5245
Mailing address:
  • Phone: 720-490-9834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: