Healthcare Provider Details

I. General information

NPI: 1992240212
Provider Name (Legal Business Name): TAYLOR BLACKWELL LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 HOLLY WAY
WEST RICHLAND WA
99353-5716
US

IV. Provider business mailing address

4820 HOLLY WAY
WEST RICHLAND WA
99353-5716
US

V. Phone/Fax

Practice location:
  • Phone: 509-362-9411
  • Fax:
Mailing address:
  • Phone: 509-362-9411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLF61367549
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number911189908
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: