Healthcare Provider Details

I. General information

NPI: 1831691351
Provider Name (Legal Business Name): REESE ELLEN TAYLOR LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1334 AGUA FRIA ST
SANTA FE NM
87501-3576
US

IV. Provider business mailing address

1000 CORDOVA PL # 804
SANTA FE NM
87505-1725
US

V. Phone/Fax

Practice location:
  • Phone: 505-699-7885
  • Fax:
Mailing address:
  • Phone: 505-699-7885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0089091
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: