MEDICARE: TAYLOR MAUREEN BARSTAD MSW, LCSW

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	104100000X	Social Worker	106907	TX
2	1041C0700X	Clinical Social Worker	106907	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	106907	OTHER	TX	PRIVATE PAY

General Provider Information

NPI Number	:	1184366718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR MAUREEN BARSTAD MSW, LCSW

Provider Business Mailing Address
First Line	:	625 E STASSNEY LN APT 3304
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-4268
Country	:	US
Telephone Number	:	307-689-6314
Fax Number	:

Provider Business Practice Location Address
First Line	:	13341 W HWY 290 STE 1-105
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78737-9160
Country	:	US
Telephone Number	:	512-640-2559
Fax Number	:	844-674-1637

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2022
Last Update Date	:	09/13/2024

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