Provider Demographics
NPI:1477613263
Name:TAYLOR, NICOLE MARY (PHD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MARY
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7212 MOGUL WAY
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46259-7765
Mailing Address - Country:US
Mailing Address - Phone:317-502-3459
Mailing Address - Fax:317-788-2120
Practice Address - Street 1:7212 MOGUL WAY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46259-7765
Practice Address - Country:US
Practice Address - Phone:317-502-3459
Practice Address - Fax:317-788-2120
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041755A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist