Provider Demographics
NPI:1386015394
Name:TAYLOR, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 CARRIAGE LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-9628
Mailing Address - Country:US
Mailing Address - Phone:601-832-0711
Mailing Address - Fax:
Practice Address - Street 1:1307 AIRPORT RD N
Practice Address - Street 2:SUITE 3C
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8897
Practice Address - Country:US
Practice Address - Phone:601-832-0711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst