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General NPI Number Information
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NPI Number | 1720262991
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Entity Type | Organization
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Legal Business Name | LAMONT T BROWN TAYLOR
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Dates
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Enumeration Date | 12/24/2007
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Last Update Date | 10/28/2016
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Provider Practice Location Address
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Address Line | 10540 S WESTERN AVE SUITE 402
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City | CHICAGO
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State | IL
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Zip | 60643-2529
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Country | US
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Telephone | 773-509-5055
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Fax | 773-509-5010
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Provider Business Mailing Address
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Address Line | PO BOX 490645
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City | CHICAGO
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State | IL
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Zip | 60649-0645
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Country | US
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Telephone | 773-509-5055
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Fax | 773-509-5010
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Authorized Official
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Title or Position | LICENSE CLINICAL SOCIAL WORKER
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Name | DR. LAMONT THEOLONUS TAYLOR
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Credential | DSW
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Telephone | 773-509-5055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 149-011481
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 149-011481
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 149-011481
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149-011481
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License Number State | IL
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