Provider Demographics
NPI:1528158763
Name:TAYLOR, AMY D (LPC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:D
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:570 PAT ST
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-6378
Mailing Address - Country:US
Mailing Address - Phone:918-453-9273
Mailing Address - Fax:918-456-8773
Practice Address - Street 1:1140 MAYBERRY DR.
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-4603
Practice Address - Country:US
Practice Address - Phone:918-456-8399
Practice Address - Fax:918-456-8773
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK2383101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health