Individual
TAYLOR AMUNDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAC, LASAC
Contact information
Practice address
5540 W GLENDALE AVE STE C102, GLENDALE, AZ 85301-2581
(623) 248-0283
Mailing address
8205 S PRIEST DR UNIT 12451, TEMPE, AZ 85284-0175
(320) 424-9604
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LAC-22446
AZ
101YA0400X
Addiction (Substance Use Disorder) Counselor
LASAC-15479
AZ
Other
Enumeration date
11/09/2023
Last updated
11/09/2023
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