Provider Demographics
NPI:1750738266
Name:DAUTAJ, TAYLOR (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:
Last Name:DAUTAJ
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2790 N ACADEMY BLVD STE 347
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5328
Mailing Address - Country:US
Mailing Address - Phone:719-407-2093
Mailing Address - Fax:
Practice Address - Street 1:2016 WOODSONG WAY APT 1352
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-1661
Practice Address - Country:US
Practice Address - Phone:817-296-4552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0018172101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health