Provider Demographics
NPI:1043988777
Name:TAYLOR, DIANN LAURINE (LPCC)
Entity Type:Individual
Prefix:
First Name:DIANN
Middle Name:LAURINE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 OLD PECOS TRL
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-9060
Mailing Address - Country:US
Mailing Address - Phone:214-288-3896
Mailing Address - Fax:
Practice Address - Street 1:4000 OLD PECOS TRL
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-9060
Practice Address - Country:US
Practice Address - Phone:214-288-3896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0218501101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional