Provider Demographics
NPI:1730905407
Name:GREEN, TAYLOR ALEXANDER (LMSW)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ALEXANDER
Last Name:GREEN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 NE RICE RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5849
Mailing Address - Country:US
Mailing Address - Phone:816-347-3069
Mailing Address - Fax:816-761-3433
Practice Address - Street 1:5904 E BANNISTER RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64134-1141
Practice Address - Country:US
Practice Address - Phone:816-966-0900
Practice Address - Fax:816-761-3433
Is Sole Proprietor?:No
Enumeration Date:2024-11-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017034346104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker