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General NPI Number Information
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NPI Number | 1164310645
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Entity Type | Individual
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Provider Name | TAYLOR MATTINGLY CSW
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Gender | Female
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Dates
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Enumeration Date | 06/25/2025
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 1011 LEHMAN AVENUE SUITE 103
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City | BOWLING GREEN
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State | KY
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Zip | 42103
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Country | US
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Telephone | 270-393-9833
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Fax | 270-393-9834
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Provider Business Mailing Address
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Address Line | 1011 LEHMAN AVENUE SUITE 103
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City | BOWLING GREEN
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State | KY
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Zip | 42103
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Country | US
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Telephone | 270-393-9833
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Fax | 270-393-9834
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 260378
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License Number State | KY
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