MEDICARE: TAYLOR FIELD THERAPEUTIC SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1033841978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAYLOR FIELD THERAPEUTIC SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 126
Second Line	:
City	:	CARSON
State	:	NM
Zip	:	87517-0126
Country	:	US
Telephone Number	:	954-232-4482
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 FREEDOM RD
Second Line	:
City	:	CARSON
State	:	NM
Zip	:	87517-8047
Country	:	US
Telephone Number	:	954-232-4482
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	TAYLOR FIELD
Credential	:	LMFT
Telephone Number	:	954-232-4482

Provider Enumeration Date	:	06/29/2022
Last Update Date	:	06/29/2022

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