Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 41239 | TX |
NPI | 1003075813 |
---|---|
Provider Name | Tanya Taylor |
First Address | Killeen, TX 76542-1331 |
Second Address | Killeen, TX 76542-1331 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2008 |
Last Update Date | 17/01/2012 |