=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275256281
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CRAIG TAYLOR MSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2022
-----------------------------------------------------
Last Update Date | 09/23/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8301 161ST AVENUE NORTHWEST SUITE 202
-----------------------------------------------------
City | REDMOND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 142-599-6859
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16340 NE 83RD ST APT A102
-----------------------------------------------------
City | REDMOND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98052-3879
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-405-1821
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 61352966
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------