Provider Demographics
NPI:1396219226
Name:WEIDNER, TAYLOR A (LPC)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:A
Last Name:WEIDNER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:A
Other - Last Name:MATTOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-0188
Mailing Address - Country:US
Mailing Address - Phone:740-773-4366
Mailing Address - Fax:740-775-7855
Practice Address - Street 1:541 SR 664 N
Practice Address - Street 2:SUITE C
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138
Practice Address - Country:US
Practice Address - Phone:740-385-6594
Practice Address - Fax:740-774-6617
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor