Provider Demographics
NPI:1356834881
Name:TAYLOR, PATRICIA (MS, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1046 N SNEAD PL
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6508
Mailing Address - Country:US
Mailing Address - Phone:208-340-2176
Mailing Address - Fax:
Practice Address - Street 1:1046 N SNEAD PL
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6508
Practice Address - Country:US
Practice Address - Phone:208-340-2176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-09
Last Update Date:2018-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC6533101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional