Provider Demographics
NPI:1003834144
Name:TAYLOR, JOHN R (LPC-S)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1048
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:TX
Mailing Address - Zip Code:76856-1048
Mailing Address - Country:US
Mailing Address - Phone:325-260-8044
Mailing Address - Fax:
Practice Address - Street 1:1310 MARTIN
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:TX
Practice Address - Zip Code:76856
Practice Address - Country:US
Practice Address - Phone:325-260-8044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11217-0506101YA0400X
TX20318101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)