Provider Demographics
NPI:1285371385
Name:TAYLOR, MARIAH MARIE (LICSW, MSW)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:MARIE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LICSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 6TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823-2053
Mailing Address - Country:US
Mailing Address - Phone:509-906-4333
Mailing Address - Fax:
Practice Address - Street 1:266 6TH AVE SW
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-2053
Practice Address - Country:US
Practice Address - Phone:509-906-4333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW611566351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW61156635OtherLICSW WA DOL LICENSE