Taylor Amundson, LAC, LASAC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

LAC-22446 Issued in AZ

Practice address

5540 W Glendale Ave Ste C102
Glendale, AZ 85301-2581

Phone

(623) 248-0283

NPI assigned

Nov 9, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• New Destiny Healing Arts Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Glendale, AZ
  • NPI 1811607807
  NPD

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

{
    "created_epoch": "1699488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699488000000",
    "number": "1780458745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8205 S PRIEST DR UNIT 12451",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852840175",
            "telephone_number": "320-424-9604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5540 W GLENDALE AVE STE C102",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853012581",
            "telephone_number": "623-248-0283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMUNDSON",
        "first_name": "TAYLOR",
        "credential": "LAC, LASAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-09",
        "last_updated": "2023-11-09",
        "certification_date": "2023-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "AZ",
            "license": "LASAC-15479",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "AZ",
            "license": "LAC-22446",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Counselor in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.