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General NPI Number Information
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NPI Number | 1578049060
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Entity Type | Individual
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Provider Name | NATHANAEL TAYLOR PH.D.
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Gender | Male
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Dates
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Enumeration Date | 07/17/2018
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Last Update Date | 03/08/2021
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Provider Practice Location Address
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Address Line | 777 BANNOCK ST
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City | DENVER
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State | CO
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Zip | 80204-4597
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Country | US
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Telephone | 303-436-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 301 E 21ST ST APT BSMT
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City | CHEYENNE
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State | WY
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Zip | 82001-3761
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Country | US
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Telephone | 806-790-9109
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSYC.00013825
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License Number State | CO
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