Provider Demographics
NPI:1699481960
Name:STUART, TAYLOR R (LPC)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:R
Last Name:STUART
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:R
Other - Last Name:O'DONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:625 CLEVELAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44702-1805
Mailing Address - Country:US
Mailing Address - Phone:330-455-0374
Mailing Address - Fax:330-453-6716
Practice Address - Street 1:625 CLEVELAND AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44702-1805
Practice Address - Country:US
Practice Address - Phone:304-452-6773
Practice Address - Fax:330-455-2101
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2406146101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0008711Medicaid