Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 11217-0506 | TX |
Y | 101YM0800X | Mental Health Counselor | 20318 | TX |
NPI | 1003834144 |
---|---|
Provider Name | John R Taylor |
First Address | Mason, TX 76856-1048 |
Second Address | Mason, TX 76856 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 18/09/2014 |