=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144046673
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | S TAYLOR & ASSOCIATES L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2024
-----------------------------------------------------
Last Update Date | 11/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3517 HILL ST SE APT 322
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97322-2803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-252-9705
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3517 HILL ST SE APT 322
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97322-2803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-252-9705
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SHANE SUMMERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 920-252-9705
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------