MEDICARE: EBONI TAYLOR LMSW

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	111128	TX

General Provider Information

NPI Number	:	1619860533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EBONI TAYLOR LMSW

Provider Business Mailing Address
First Line	:	24002 COLONIAL PKWY APT 2107
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77493-3991
Country	:	US
Telephone Number	:	337-349-4634
Fax Number	:

Provider Business Practice Location Address
First Line	:	24002 COLONIAL PKWY APT 2107
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77493-3991
Country	:	US
Telephone Number	:	337-349-4634
Fax Number	:

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

Provider Enumeration Date	:	05/30/2025
Last Update Date	:	05/30/2025

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Directions to “ EBONI TAYLOR LMSW” Practice Location

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