Provider Demographics
NPI:1144762873
Name:HORNBACK, TAYLOR J
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:J
Last Name:HORNBACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 CUBA RD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-6809
Mailing Address - Country:US
Mailing Address - Phone:270-247-2588
Mailing Address - Fax:
Practice Address - Street 1:1525 CUBA RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-6809
Practice Address - Country:US
Practice Address - Phone:270-247-2588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-11
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health