Provider Demographics
NPI:1487245072
Name:TAYLOR, JOVANA
Entity type:Individual
Prefix:
First Name:JOVANA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 KELLINGTON DR N APT 4207
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-1581
Mailing Address - Country:US
Mailing Address - Phone:346-288-2091
Mailing Address - Fax:
Practice Address - Street 1:611 ROCKMEAD DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2258
Practice Address - Country:US
Practice Address - Phone:281-713-8980
Practice Address - Fax:281-713-8938
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-19-95297106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician