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General NPI Number Information
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NPI Number | 1326352469
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Entity Type | Individual
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Provider Name | JONATHAN COLLINS TAYLOR LCSW
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Gender | Male
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Dates
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Enumeration Date | 07/30/2010
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Last Update Date | 09/10/2013
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Provider Practice Location Address
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Address Line | 1325 N MAIN ST STE 3
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City | BOUNTIFUL
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State | UT
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Zip | 84010-6090
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Country | US
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Telephone | 801-648-9021
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Fax | 801-335-4783
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Provider Business Mailing Address
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Address Line | 1325 N MAIN ST STE 3
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City | BOUNTIFUL
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State | UT
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Zip | 84010-6090
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Country | US
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Telephone | 801-648-9021
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Fax | 801-335-4783
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8033286-3501
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License Number State | UT
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