Provider Demographics
NPI:1386853240
Name:PILKENTON-TAYLOR, CAROLYN RUTH (MA,CADC I,LPC,QMHP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:RUTH
Last Name:PILKENTON-TAYLOR
Suffix:
Gender:F
Credentials:MA,CADC I,LPC,QMHP
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:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-0579
Mailing Address - Country:US
Mailing Address - Phone:541-766-6146
Mailing Address - Fax:541-766-6186
Practice Address - Street 1:530 NW 27TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-5223
Practice Address - Country:US
Practice Address - Phone:541-766-6146
Practice Address - Fax:541-766-6186
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2321101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional