Provider Demographics
NPI:1508262452
Name:TAYLOR, NATHAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 KHURSANIYAH
Mailing Address - Street 2:P.O. BOX 6616
Mailing Address - City:DHAHRAN
Mailing Address - State:EASTERN PROVINCE
Mailing Address - Zip Code:31311
Mailing Address - Country:SA
Mailing Address - Phone:9665-003-5054
Mailing Address - Fax:
Practice Address - Street 1:559 KHURSANIYAH
Practice Address - Street 2:
Practice Address - City:DHAHRAN
Practice Address - State:EASTERN PROVINCE
Practice Address - Zip Code:31311
Practice Address - Country:SA
Practice Address - Phone:9665-003-5054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1249103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1249OtherNC LICENSE NUMBER