Basic Information
| Provider Information | |||||||||
| NPI: | 1124559224 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURROUGHS | ||||||||
| FirstName: | TAYLOR | ||||||||
| MiddleName: | |||||||||
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| Credential: | QMHS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 118 W JACKSON ST STE B | ||||||||
| Address2: | |||||||||
| City: | WEST UNITY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435709643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192212821 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 600 FREEDOM DR | ||||||||
| Address2: | |||||||||
| City: | NAPOLEON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435459038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199551660 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2017 | ||||||||
| LastUpdateDate: | 10/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | Y | Other Service Providers | Community Health Worker | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor |
No ID Information.