Healthcare Provider Details

I. General information

NPI: 1427537125
Provider Name (Legal Business Name): NICOLE TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 BROADWAY STE 404
TACOMA WA
98402-4454
US

IV. Provider business mailing address

9407 NE VANCOUVER MALL DR STE 104
VANCOUVER WA
98662-6191
US

V. Phone/Fax

Practice location:
  • Phone: 206-774-8557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61689917
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: