Provider Demographics
NPI:1497890511
Name:TAYLOR, GAIL L (LPC)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:L
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 1:17 FINLAY FLDS
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63021-6757
Mailing Address - Country:US
Mailing Address - Phone:636-391-6773
Mailing Address - Fax:636-391-6773
Practice Address - Street 1:217 SUPPIGER LN
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-1132
Practice Address - Country:US
Practice Address - Phone:618-654-5990
Practice Address - Fax:636-391-6773
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003032158101YP2500X
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional