Provider Demographics
NPI:1437227774
Name:TAYLOR, JAN G (MS LSPE)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:G
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS LSPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 845
Mailing Address - Street 2:
Mailing Address - City:MONTEAGLE
Mailing Address - State:TN
Mailing Address - Zip Code:37356
Mailing Address - Country:US
Mailing Address - Phone:931-924-2004
Mailing Address - Fax:931-924-4900
Practice Address - Street 1:123 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MONTEAGLE
Practice Address - State:TN
Practice Address - Zip Code:37356
Practice Address - Country:US
Practice Address - Phone:931-924-2004
Practice Address - Fax:931-924-4900
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3135221OtherBCBS