Provider Demographics
NPI:1487330288
Name:ROBINSON, TAYLOR RAEANN (BCABA)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:RAEANN
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 E BLVD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-2271
Mailing Address - Country:US
Mailing Address - Phone:765-461-1245
Mailing Address - Fax:765-319-0660
Practice Address - Street 1:114 EAST STREETER AVENUE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303
Practice Address - Country:US
Practice Address - Phone:765-587-4895
Practice Address - Fax:765-319-0660
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0-22-13518106E00000X
IN1-24-74393103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst