Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 79472 | TX |
Y | 101YM0800X | Mental Health Counselor | 79472 | TX |
NPI | 1003436239 |
---|---|
Provider Name | Dennis Taylor |
First Address | Argyle, TX 76226-2503 |
Second Address | Argyle, TX 76226-2503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2020 |
Last Update Date | 17/04/2020 |