Provider Demographics
NPI:1659992345
Name:COLBERT, TAYLOR MARIE (LMHC)
Entity type:Individual
Prefix:MISS
First Name:TAYLOR
Middle Name:MARIE
Last Name:COLBERT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 BOICEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKTONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:14817-9571
Mailing Address - Country:US
Mailing Address - Phone:917-715-4452
Mailing Address - Fax:
Practice Address - Street 1:455 BOICEVILLE RD
Practice Address - Street 2:
Practice Address - City:BROOKTONDALE
Practice Address - State:NY
Practice Address - Zip Code:14817-9571
Practice Address - Country:US
Practice Address - Phone:917-715-4452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011832101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty