Provider Demographics
NPI:1285968685
Name:TAYLOR, JANNELL (LPC)
Entity type:Individual
Prefix:MS
First Name:JANNELL
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:JANNELL
Other - Middle Name:HART
Other - Last Name:AMRINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2901 WOODMONT TR.
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133
Mailing Address - Country:US
Mailing Address - Phone:817-437-1226
Mailing Address - Fax:
Practice Address - Street 1:3309 WINTHROP AVE.
Practice Address - Street 2:#90
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116
Practice Address - Country:US
Practice Address - Phone:817-437-1226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63147101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX63147OtherBOARD OF EXAM PROF COUN
TX285392101Medicaid
TX101YP2500XOtherTAXONOMY
TX#63147OtherLPC