Provider Demographics
NPI:1114551868
Name:TAYLOR, HAROLD WAYNE JR (MS MFT)
Entity Type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:WAYNE
Last Name:TAYLOR
Suffix:JR
Gender:M
Credentials:MS MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 W B ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-3610
Mailing Address - Country:US
Mailing Address - Phone:479-858-7111
Mailing Address - Fax:
Practice Address - Street 1:814 W B ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-3610
Practice Address - Country:US
Practice Address - Phone:479-858-7111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARM2003002106H00000X
ARP2003029101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist