Provider Demographics
NPI:1285258897
Name:TAYLOR, SAMANTHA JOYCE
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:JOYCE
Last Name:TAYLOR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7040 LAREDO ST STE K
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-3044
Mailing Address - Country:US
Mailing Address - Phone:702-331-4874
Mailing Address - Fax:702-446-8034
Practice Address - Street 1:720 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-3614
Practice Address - Country:US
Practice Address - Phone:702-331-4874
Practice Address - Fax:702-446-8034
Is Sole Proprietor?:No
Enumeration Date:2020-05-31
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPENDING101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health