Provider Demographics
NPI:1003055831
Name:TAYLOR, CYNTHIA JOY (REGISTERED COUNSELOR)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:JOY
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:REGISTERED COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 14TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632
Mailing Address - Country:US
Mailing Address - Phone:360-423-0203
Mailing Address - Fax:360-577-0269
Practice Address - Street 1:615 8TH STREET
Practice Address - Street 2:
Practice Address - City:HOQUIAM
Practice Address - State:WA
Practice Address - Zip Code:98550
Practice Address - Country:US
Practice Address - Phone:360-532-4357
Practice Address - Fax:360-538-0124
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC 60062771101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARC 60062771OtherWASHINGTON STATE DEPARTMENT OF HEALTH