Healthcare Provider Details

I. General information

NPI: 1043314669
Provider Name (Legal Business Name): CRYSTAL FAITH TAYLOR MSW, CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 NEWTOWN PIKE
LEXINGTON KY
40511-1275
US

IV. Provider business mailing address

1351 NEWTOWN PIKE
LEXINGTON KY
40511-1275
US

V. Phone/Fax

Practice location:
  • Phone: 859-253-1686
  • Fax:
Mailing address:
  • Phone: 859-253-1686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number3624
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: