Provider Demographics
NPI:1144869793
Name:TAYLOR, KRISTEN SHRIEE (LICSW, LCSW)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:SHRIEE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LICSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 LAKEPLACE DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:AL
Mailing Address - Zip Code:35959-5144
Mailing Address - Country:US
Mailing Address - Phone:256-557-5513
Mailing Address - Fax:
Practice Address - Street 1:4850 LAKEPLACE DR
Practice Address - Street 2:
Practice Address - City:CEDAR BLUFF
Practice Address - State:AL
Practice Address - Zip Code:35959-5144
Practice Address - Country:US
Practice Address - Phone:256-557-5513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACSW006450OtherLCSW
AL4118COtherLICSW