Provider Demographics
NPI:1346752821
Name:TAYLOR, BRIAN LANE (QASP)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:LANE
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:QASP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3106 S W S YOUNG DR STE 105
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-2007
Mailing Address - Country:US
Mailing Address - Phone:325-450-5042
Mailing Address - Fax:
Practice Address - Street 1:3106 S W S YOUNG DR STE 105
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542
Practice Address - Country:US
Practice Address - Phone:325-450-5042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-24
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8736106E00000X
1-18-30819103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst