Provider Demographics
NPI:1437919867
Name:TAYLOR, WILLIAM OCIE JR (LAC CCDP CADAC II)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:OCIE
Last Name:TAYLOR
Suffix:JR
Gender:M
Credentials:LAC CCDP CADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10334 E 21ST PL
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-2105
Mailing Address - Country:US
Mailing Address - Phone:317-894-1045
Mailing Address - Fax:
Practice Address - Street 1:535 E 38TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-2767
Practice Address - Country:US
Practice Address - Phone:317-921-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86000017A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)