Healthcare Provider Details

I. General information

NPI: 1265122014
Provider Name (Legal Business Name): CALOB LAMAR TAYLOR LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 S GREELEY HWY STE B
CHEYENNE WY
82007-3063
US

IV. Provider business mailing address

5001 GRANDVIEW AVE
CHEYENNE WY
82009-4935
US

V. Phone/Fax

Practice location:
  • Phone: 307-202-4005
  • Fax: 307-448-4708
Mailing address:
  • Phone: 307-640-3360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-1802
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: