Provider Demographics
NPI:1093768418
Name:TAYLOR, WILLIAM R (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:R
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VAMC
Mailing Address - Street 2:2495 SHREVEPORT HIGHWAY
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-9904
Mailing Address - Country:US
Mailing Address - Phone:318-473-0010
Mailing Address - Fax:318-483-5064
Practice Address - Street 1:VAMC
Practice Address - Street 2:2495 SHREVEPORT HIGHWAY
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-9904
Practice Address - Country:US
Practice Address - Phone:318-473-0010
Practice Address - Fax:318-483-5064
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA86241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical