Individual
KENNETH JAMES TAYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
707 N 7TH AVE, POCATELLO, ID 83201-5785
(208) 242-3044
Mailing address
707 N 7TH AVE STE D, POCATELLO, ID 83201-5796
(208) 242-3044
(208) 904-0494
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
10046
ID
104100000X
Social Worker
37236
ID
1041C0700X
Clinical Social Worker
Primary
LCSW-42204
ID
Other
Enumeration date
04/08/2018
Last updated
04/20/2026
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