Individual provider Active NPI

Llama Taylor, L.C.S.W.

  • Clinical Social Worker
  • Dallas, OR
National Provider Identifier
1316150220
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
L3652 Issued in OR
Practice address
2200 E Ellendale Ave
Dallas, OR 97338-9353
Phone
(503) 623-5588
Fax
(503) 623-4729
NPI assigned
May 7, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X L3652 OR Primary

Addresses

Primary practice location

2200 E Ellendale Ave
Dallas, OR 97338-9353

Mailing address

2200 E Ellendale Ave
Dallas, OR 97338-9353

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Oct 17, 2022 through Oct 17, 2026

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
L3652ORMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Polk Adolescent Day Treatment Center Inc Past Accepting new patients
Eola Mental Health Services Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1316150220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 E ELLENDALE AVE",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973389353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 E ELLENDALE AVE",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973389353",
            "telephone_number": "503-623-5588",
            "fax_number": "503-623-4729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAYLOR",
        "first_name": "LLAMA",
        "credential": "L.C.S.W.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L3652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, OR

Sources for this page

Verify at the official NPI Registry.