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Individual
MARK SHANNON TAYLOR
Active
Individual
MARK SHANNON TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AAC
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
CAAR.CG.60943113
WA
Other
Enumeration date
02/28/2019
Last updated
02/28/2019
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