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General NPI Number Information
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NPI Number | 1295240612
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Entity Type | Individual
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Provider Name | SAMUEL TAYLOR LPC
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Gender | Male
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Dates
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Enumeration Date | 12/07/2017
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Last Update Date | 01/07/2019
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Provider Practice Location Address
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Address Line | 77 E WELDON AVE STE 210
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City | PHOENIX
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State | AZ
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Zip | 85012-2380
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Country | US
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Telephone | 602-230-7373
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Fax | 602-761-2537
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Provider Business Mailing Address
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Address Line | 3620 N 3RD ST
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City | PHOENIX
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State | AZ
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Zip | 85012-2020
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Country | US
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Telephone | 602-230-7373
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Fax | 602-682-7455
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 17054
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License Number State | AZ
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