Healthcare Provider Details

I. General information

NPI: 1619130937
Provider Name (Legal Business Name): CARON LORRAINE TAYLOE MFT, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 E PLUMB LN STE 100
RENO NV
89502-3543
US

IV. Provider business mailing address

575 E PLUMB LN STE 100
RENO NV
89502-3543
US

V. Phone/Fax

Practice location:
  • Phone: 775-329-0623
  • Fax: 775-337-2971
Mailing address:
  • Phone: 775-329-0623
  • Fax: 775-337-2971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number601
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: