Provider Demographics
NPI:1598563413
Name:FORD, TAYLOR
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:FORD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:886 QUARTERHORSE RUN
Mailing Address - Street 2:
Mailing Address - City:BARGERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46106-8727
Mailing Address - Country:US
Mailing Address - Phone:317-445-2903
Mailing Address - Fax:
Practice Address - Street 1:886 QUARTERHORSE RUN
Practice Address - Street 2:
Practice Address - City:BARGERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46106-8727
Practice Address - Country:US
Practice Address - Phone:317-445-2903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-22-220948106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician