Provider Demographics
NPI:1366413957
Name:TAYLOR, NANCY J (MC LPC RPT)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:J
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MC LPC RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 E CARSON DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7215
Mailing Address - Country:US
Mailing Address - Phone:480-752-3010
Mailing Address - Fax:
Practice Address - Street 1:2435 E SOUTHERN AVE STE 3
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7628
Practice Address - Country:US
Practice Address - Phone:480-894-2281
Practice Address - Fax:480-894-2282
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC10994101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ738731000OtherMAGELLAN
AZ885171OtherAHCCCS
7521626OtherAETNA