Healthcare Provider Details

I. General information

NPI: 1750873857
Provider Name (Legal Business Name): TAYLOR SANDRA HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 SW 152ND ST
BURIEN WA
98166-1845
US

IV. Provider business mailing address

1033 SW 152ND ST. BURIEN, WA 98166
BURIEN WA
98166
US

V. Phone/Fax

Practice location:
  • Phone: 206-829-1100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: