Provider Demographics
NPI:1235217415
Name:TAYLOR, ROBERT W (LPC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:W
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:ROB
Other - Middle Name:W
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:705 ILLINOIS AVE
Mailing Address - Street 2:STE 22
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-5067
Mailing Address - Country:US
Mailing Address - Phone:417-627-9994
Mailing Address - Fax:417-627-9995
Practice Address - Street 1:705 ILLINOIS AVE
Practice Address - Street 2:STE 22
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-5067
Practice Address - Country:US
Practice Address - Phone:417-627-9994
Practice Address - Fax:417-627-9995
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002047101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO498559509Medicaid