Provider Demographics
NPI:1528314887
Name:TAYLOR, ANTHONY DEWAYNE
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:DEWAYNE
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 1:804 WENDY LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5924
Mailing Address - Country:US
Mailing Address - Phone:405-330-0724
Mailing Address - Fax:
Practice Address - Street 1:804 WENDY LN
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5924
Practice Address - Country:US
Practice Address - Phone:405-330-0724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)