Provider Demographics
NPI:1306468350
Name:TAYLOR, MARTIE BRIANNA (LPCA)
Entity type:Individual
Prefix:
First Name:MARTIE
Middle Name:BRIANNA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 S MONROE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-1462
Mailing Address - Country:US
Mailing Address - Phone:270-378-1005
Mailing Address - Fax:
Practice Address - Street 1:106 CEMETERY RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:KY
Practice Address - Zip Code:40033-1827
Practice Address - Country:US
Practice Address - Phone:270-321-4198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251253101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health