Provider Demographics
NPI:1477127520
Name:TAYLOR, TAMRA MARIE (LCPC)
Entity Type:Individual
Prefix:
First Name:TAMRA
Middle Name:MARIE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 W CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:GILLESPIE
Mailing Address - State:IL
Mailing Address - Zip Code:62033-1503
Mailing Address - Country:US
Mailing Address - Phone:217-839-7200
Mailing Address - Fax:
Practice Address - Street 1:118 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:GILLESPIE
Practice Address - State:IL
Practice Address - Zip Code:62033-1503
Practice Address - Country:US
Practice Address - Phone:217-839-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.013600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health