Provider Demographics
NPI:1275876815
Name:TAYLOR, JESSICA LYNN (MA, LPCC-S)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:LYNN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MA, LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7217 HAWTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4632
Mailing Address - Country:US
Mailing Address - Phone:440-589-6500
Mailing Address - Fax:440-589-6555
Practice Address - Street 1:8518 MENTOR AVE STE H
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5838
Practice Address - Country:US
Practice Address - Phone:440-589-6500
Practice Address - Fax:440-589-6555
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-02
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC1100260101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2864093-1Medicaid