MEDICARE: EBONI TAYLOR MAMFT

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	MI4547	NV

General Provider Information

NPI Number	:	1619414612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EBONI TAYLOR MAMFT

Provider Business Mailing Address
First Line	:	8250 N GRAND CANYON DR UNIT 1147
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-3738
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8250 N GRAND CANYON DR UNIT 1147
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-3738
Country	:	US
Telephone Number	:	702-526-3387
Fax Number	:

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

Provider Enumeration Date	:	01/27/2017
Last Update Date	:	11/05/2025

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