Provider Demographics
NPI:1972887115
Name:TAYLOR, EDWARD V SR
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:V
Last Name:TAYLOR
Suffix:SR
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 1:729 NE 32ND ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-7530
Mailing Address - Country:US
Mailing Address - Phone:405-962-9575
Mailing Address - Fax:405-600-9953
Practice Address - Street 1:729 NE 32ND ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-7530
Practice Address - Country:US
Practice Address - Phone:405-962-9575
Practice Address - Fax:405-600-9953
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health