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NPI Code Detail

MEDICARE: MR. JEFFERY TAYLOR LCSW

MEDICARE: MR. JEFFERY TAYLOR 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
11041C0700XClinical Social Worker15351AZ

General Provider Information

NPI Number : 1467627703
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JEFFERY TAYLOR LCSW
Provider Business Mailing Address
First Line : 6762 S HAUNTED CANYON RD
Second Line :
City : GOLD CANYON
State : AZ
Zip : 85118-4760
Country : US
Telephone Number : 480-667-3325
Fax Number :
Provider Business Practice Location Address
First Line : 1910 S STAPLEY DR STE 209
Second Line :
City : MESA
State : AZ
Zip : 85204-6679
Country : US
Telephone Number : 480-351-8020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2008
Last Update Date : 12/13/2025

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