Provider Demographics
NPI:1982254678
Name:CARTER, TAYLOR MARIE
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MARIE
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 RUSK ST APT 212
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-3439
Mailing Address - Country:US
Mailing Address - Phone:847-970-1985
Mailing Address - Fax:
Practice Address - Street 1:20915 KINGSLAND BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-5548
Practice Address - Country:US
Practice Address - Phone:281-579-0703
Practice Address - Fax:281-398-9719
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
TX1037471041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No172V00000XOther Service ProvidersCommunity Health Worker
No104100000XBehavioral Health & Social Service ProvidersSocial Worker