Provider Demographics
NPI:1225642390
Name:TAYLOR, CAROL HOWELL (MED)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:HOWELL
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4405 FOSTER RD
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76384-7505
Mailing Address - Country:US
Mailing Address - Phone:940-357-1387
Mailing Address - Fax:
Practice Address - Street 1:1914 PARADISE ST
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-8111
Practice Address - Country:US
Practice Address - Phone:940-553-1631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13878101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX13878OtherLICENSED PROFESSIONAL COUNSELOR