Provider Demographics
NPI:1063547214
Name:TAYLOR, RICHARD REYNOLDS (MS)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:REYNOLDS
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:18802 EVERGREEN TER
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64505-4054
Mailing Address - Country:US
Mailing Address - Phone:314-727-9070
Mailing Address - Fax:816-271-6573
Practice Address - Street 1:3510 FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2987
Practice Address - Country:US
Practice Address - Phone:314-727-9070
Practice Address - Fax:816-271-6573
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001890103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical