Provider Demographics
NPI:1396251856
Name:LOUCKS, TAYLOR (BCBA)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:LOUCKS
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3107 W COLORADO AVE # 118
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-2040
Mailing Address - Country:US
Mailing Address - Phone:720-563-1736
Mailing Address - Fax:
Practice Address - Street 1:2822 W CUCHARRAS ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-2448
Practice Address - Country:US
Practice Address - Phone:720-563-1736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician