Provider Demographics
NPI:1154971810
Name:TAYLOR, MELISSA SHILOH (LCSW)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:SHILOH
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 SEMINOLE DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-7004
Mailing Address - Country:US
Mailing Address - Phone:865-235-2351
Mailing Address - Fax:
Practice Address - Street 1:3114 BROWNS MILL RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-1417
Practice Address - Country:US
Practice Address - Phone:423-631-0432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN85431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical