Provider Demographics
NPI:1275387540
Name:TAYLOR, JUDY MAUDINE (THE TAYLOR FAMILY)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:MAUDINE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:THE TAYLOR FAMILY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5515 W LOOP 281
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75602-5440
Mailing Address - Country:US
Mailing Address - Phone:213-297-7122
Mailing Address - Fax:646-559-6670
Practice Address - Street 1:5515 W LOOP 281
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75602-5440
Practice Address - Country:US
Practice Address - Phone:213-297-7122
Practice Address - Fax:646-559-6670
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMEDICAIDMedicaid
TXMEDICAREMedicaid