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NPI Code Detail

MEDICARE: MR. OMAR D TAYLOR R.C

MEDICARE: MR. OMAR D TAYLOR R.C
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1508148271
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. OMAR D TAYLOR R.C
Provider Business Mailing Address
First Line : 12350 W 18TH DR
Second Line :
City : LAKEWOOD
State : CO
Zip : 80215-2515
Country : US
Telephone Number : 303-241-3689
Fax Number :
Provider Business Practice Location Address
First Line : 1450 S ASH ST
Second Line :
City : DENVER
State : CO
Zip : 80222-3629
Country : US
Telephone Number : 303-377-2586
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2011
Last Update Date : 09/19/2011

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