MEDICARE: BRANDON ROBERT TAYLOR

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1548039142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON ROBERT TAYLOR

Provider Business Mailing Address
First Line	:	4995 LANE CREEK RD
Second Line	:
City	:	CENTRAL POINT
State	:	OR
Zip	:	97502-9711
Country	:	US
Telephone Number	:	707-396-3115
Fax Number	:

Provider Business Practice Location Address
First Line	:	4995 LANE CREEK RD
Second Line	:
City	:	CENTRAL POINT
State	:	OR
Zip	:	97502-9711
Country	:	US
Telephone Number	:	707-396-3115
Fax Number	:

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

Provider Enumeration Date	:	12/22/2023
Last Update Date	:	12/22/2023

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Directions to “ BRANDON ROBERT TAYLOR ” Practice Location

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