Provider Demographics
NPI:1275860462
Name:TAYLOR, CHERYL ELLEN (MA EDS)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ELLEN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MA EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 12TH STREET
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2352
Mailing Address - Country:US
Mailing Address - Phone:304-487-7936
Mailing Address - Fax:304-487-7835
Practice Address - Street 1:1333 SOUTHVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-4317
Practice Address - Country:US
Practice Address - Phone:304-325-4673
Practice Address - Fax:304-327-9210
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0103TS0200X
WV997103TC0700X, 103TC1900X, 103TF0200X, 103TP2701X, 103TM1800X, 103T00000X
997103TC2200X, 103TB0200X, 103TF0000X, 103TF0200X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810016308Medicaid