Healthcare Provider Details

I. General information

NPI: 1275465635
Provider Name (Legal Business Name): TAYLOR COLLERAN LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 S BRIDGEWAY PL STE 280
EAGLE ID
83616-6834
US

IV. Provider business mailing address

366 S SUNSET POINT WAY
MERIDIAN ID
83642-5495
US

V. Phone/Fax

Practice location:
  • Phone: 208-412-7740
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6281715
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: