Basic Information
| Provider Information | |||||||||
| NPI: | 1740208206 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | HUDSON | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 CHILDRENS DR | ||||||||
| Address2: | PSYCHOLOGY DEPARTMENT | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147224700 | ||||||||
| FaxNumber: | 6147224718 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 CHILDRENS DR | ||||||||
| Address2: | PSYCHOLOGY DEPARTMENT | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147224700 | ||||||||
| FaxNumber: | 6147224718 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 06/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 4058 | OH | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 000000526162 | 01 | OH | ANTHEM | OTHER | 1473276 | 05 | OH | MEDICAID | 680001710 | 01 | OH | RAILROAD MEDICARE | OTHER | 716587 | 01 | OH | BCMH | OTHER | 7697545 | 01 | OH | AETNA | OTHER | P00333039 | 01 | OH | RAILROAD MEDICARE | OTHER | P00420613 | 01 | OH | RAILROAD MEDICARE | OTHER | 364074 | 01 | OH | WELLCARE | OTHER | 473369000 | 01 | OH | MAGELLAN | OTHER | 000000028299 | 01 | OH | ANTHEM | OTHER | 000000221378 | 01 | OH | UNISON | OTHER |