Provider Demographics
NPI:1033876560
Name:OCASIO, TAYLOR STAN (LPC)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:STAN
Last Name:OCASIO
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14215 SW TEAL BLVD APT E
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-4371
Mailing Address - Country:US
Mailing Address - Phone:360-448-0670
Mailing Address - Fax:
Practice Address - Street 1:14215 SW TEAL BLVD APT E
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-4371
Practice Address - Country:US
Practice Address - Phone:503-877-9881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-18
Last Update Date:2022-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR6249101YM0800X
ORC6904101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health