Healthcare Provider Details

I. General information

NPI: 1316871460
Provider Name (Legal Business Name): SPENCER TAYLOR
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 N ALAMEDA BLVD
LAS CRUCES NM
88005-2291
US

IV. Provider business mailing address

1990 WYOMING AVE APT 25
LAS CRUCES NM
88001-5875
US

V. Phone/Fax

Practice location:
  • Phone: 575-520-1522
  • Fax:
Mailing address:
  • Phone: 575-405-3078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2026-0762
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: