Provider Demographics
NPI:1962072603
Name:MCCAULLEY, TAYLOR (PLPC)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:MCCAULLEY
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-4605
Mailing Address - Country:US
Mailing Address - Phone:337-935-2310
Mailing Address - Fax:
Practice Address - Street 1:525 E BRIDGE ST
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-4605
Practice Address - Country:US
Practice Address - Phone:337-935-2310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor