Provider Demographics
NPI:1386174928
Name:TAYLOR, NICHOL (AMFT)
Entity type:Individual
Prefix:
First Name:NICHOL
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 N 840 W
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-9213
Mailing Address - Country:US
Mailing Address - Phone:801-310-0708
Mailing Address - Fax:
Practice Address - Street 1:135 W CENTER ST
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-2207
Practice Address - Country:US
Practice Address - Phone:801-785-1169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10405246-3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist