Provider Demographics
NPI:1437723186
Name:TAYLOR, JACQUELINE S (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:S
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 QUEENS WOOD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-7722
Mailing Address - Country:US
Mailing Address - Phone:601-454-5837
Mailing Address - Fax:
Practice Address - Street 1:877 NORTHPARK DR STE 400
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-5220
Practice Address - Country:US
Practice Address - Phone:601-454-5837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2833101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health