Provider Demographics
NPI:1154305464
Name:TAYLOR, JULIAN MARIS (LPC)
Entity Type:Individual
Prefix:MR
First Name:JULIAN
Middle Name:MARIS
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 1:2425 FAIRWAY DR SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-3419
Mailing Address - Country:US
Mailing Address - Phone:540-342-1968
Mailing Address - Fax:
Practice Address - Street 1:2727 ELECTRIC RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3547
Practice Address - Country:US
Practice Address - Phone:540-772-5140
Practice Address - Fax:540-772-5157
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701000584101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA183301OtherANTHEM BC BS
VA183301OtherANTHEM BC BS