Basic Information
| Provider Information | |||||||||
| NPI: | 1528158763 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 570 PAT ST | ||||||||
| Address2: | |||||||||
| City: | TAHLEQUAH | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744646378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184539273 | ||||||||
| FaxNumber: | 9184568773 | ||||||||
| Practice Location | |||||||||
| Address1: | 1140 MAYBERRY DR. | ||||||||
| Address2: | |||||||||
| City: | TAHLEQUAH | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744644603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184568399 | ||||||||
| FaxNumber: | 9184568773 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 2383 | OK | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.