Provider Demographics
NPI:1225499320
Name:TAYLOR, MATTHEW DANIEL (MS, LCPC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DANIEL
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 TERRYSYDE CT
Mailing Address - Street 2:B
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-2610
Mailing Address - Country:US
Mailing Address - Phone:410-218-7302
Mailing Address - Fax:
Practice Address - Street 1:25 EAST ELLENDALE STREET
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-2610
Practice Address - Country:US
Practice Address - Phone:410-638-5168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2017-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7617101YM0800X
MDLC1174101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health