Provider Demographics
NPI:1316285265
Name:TAYLOR, JAMES AUBREY
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:AUBREY
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 BROADWAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3735
Mailing Address - Country:US
Mailing Address - Phone:253-473-7586
Mailing Address - Fax:253-590-0211
Practice Address - Street 1:702 BROADWAY
Practice Address - Street 2:SUITE 102
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3735
Practice Address - Country:US
Practice Address - Phone:253-473-7586
Practice Address - Fax:253-590-0211
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO 60297029101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)