Provider Demographics
NPI:1124215215
Name:TAYLOR, MARC GANDY (LPC)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:GANDY
Last Name:TAYLOR
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 1:506 S COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-3508
Mailing Address - Country:US
Mailing Address - Phone:601-442-0412
Mailing Address - Fax:601-443-2359
Practice Address - Street 1:54 SEAGENT PRENTISS DR
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-0000
Practice Address - Country:US
Practice Address - Phone:601-443-2131
Practice Address - Fax:601-443-2359
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS485101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional