Provider Demographics
NPI:1992240212
Name:BLACKWELL, TAYLOR (LMFT)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 S GRAND BLVD STE 101S
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-2272
Mailing Address - Country:US
Mailing Address - Phone:509-362-9411
Mailing Address - Fax:
Practice Address - Street 1:1403 S GRAND BLVD STE 101S
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-2272
Practice Address - Country:US
Practice Address - Phone:509-362-9411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA911189908101YA0400X
WALF61367549101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1104539030OtherBUSINESS NPI NUMBER