Provider Demographics
NPI:1285846840
Name:TAYLOR, PEGGY SUE (PSYD)
Entity type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:SUE
Last Name:TAYLOR
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 418
Mailing Address - Street 2:
Mailing Address - City:COLORADO CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86021-0418
Mailing Address - Country:US
Mailing Address - Phone:435-900-1104
Mailing Address - Fax:
Practice Address - Street 1:20 S COLVIN ST.
Practice Address - Street 2:
Practice Address - City:COLORADO CITY
Practice Address - State:AZ
Practice Address - Zip Code:86021
Practice Address - Country:US
Practice Address - Phone:435-900-1104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5335545-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical