Provider Demographics
NPI:1295852887
Name:TAYLOR, MARK L (MS LPC NCC NCPC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:L
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MS LPC NCC NCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 E DOWNING ST
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-3014
Mailing Address - Country:US
Mailing Address - Phone:918-506-4012
Mailing Address - Fax:918-506-4013
Practice Address - Street 1:308 EAST DOWNING STREET
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-4603
Practice Address - Country:US
Practice Address - Phone:918-506-4012
Practice Address - Fax:918-506-4013
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3556101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100734620HMedicaid
OK200053340BMedicaid