MEDICARE: MS. KALONI KAYE TAYLOR MSW, 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
1	101YM0800X	Mental Health Counselor	434-LCSW	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000071471	OTHER	MT	CHIPS

General Provider Information

NPI Number	:	1689838807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KALONI KAYE TAYLOR MSW, LCSW

Provider Business Mailing Address
First Line	:	2319 15TH AVE S
Second Line	:	#2
City	:	GREAT FALLS
State	:	MT
Zip	:	59405-5036
Country	:	US
Telephone Number	:	406-231-1114
Fax Number	:

Provider Business Practice Location Address
First Line	:	2319 15TH AVE S
Second Line	:	#2
City	:	GREAT FALLS
State	:	MT
Zip	:	59405-5036
Country	:	US
Telephone Number	:	406-231-1114
Fax Number	:

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

Provider Enumeration Date	:	07/16/2008
Last Update Date	:	07/16/2008

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