Provider Demographics
NPI:1114916574
Name:TAYLOR-AUSTIN, LISA A (NCC, LPC, LMHC, CFMH)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:A
Last Name:TAYLOR-AUSTIN
Suffix:
Gender:F
Credentials:NCC, LPC, LMHC, CFMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 BOSTON POST RD STE 3-1118
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-2578
Mailing Address - Country:US
Mailing Address - Phone:203-522-6164
Mailing Address - Fax:855-855-1870
Practice Address - Street 1:57 PLAINS RD
Practice Address - Street 2:SUITE 2C
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06461-2573
Practice Address - Country:US
Practice Address - Phone:203-522-6164
Practice Address - Fax:855-855-1870
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0019290101YP2500X
CT1282101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008069396981Medicaid
CT291145000OtherMAGELLAN
CT108346OtherUBH
CT240001282CT02OtherANTHEM
CT264405OtherMHN
CT60054OtherAETNA
CO9000227085Medicaid