Healthcare Provider Details

I. General information

NPI: 1699741264
Provider Name (Legal Business Name): GAYLE M TAYLOR-FORD LSCSW, LCAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 GRAPHIC ARTS RD STE 100
EMPORIA KS
66801-6204
US

IV. Provider business mailing address

420 KENNEDY ST
BURLINGTON KS
66839-1120
US

V. Phone/Fax

Practice location:
  • Phone: 620-208-6480
  • Fax: 620-364-2551
Mailing address:
  • Phone: 620-364-2606
  • Fax: 620-364-2551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4194
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number410
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: