Basic Information
| Provider Information | |||||||||
| NPI: | 1659414522 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD, MASTERSPUBHLTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6765 CORPORATE BLVD., #5306 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70809 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 422 COLONIAL DR | ||||||||
| Address2: | COMMUNITY EMPOWERMENT SERVICES | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708066505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252925151 | ||||||||
| FaxNumber: | 2252925152 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2007 | ||||||||
| LastUpdateDate: | 08/13/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MD15104R | LA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 1038938 | 05 | LA | MEDICAID | FT4000078 | 01 | LA | DEA | OTHER |