Provider Demographics
NPI:1538453642
Name:TAYLOR, JESSICA NICOLE (LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 453
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-0453
Mailing Address - Country:US
Mailing Address - Phone:870-919-3230
Mailing Address - Fax:870-345-7235
Practice Address - Street 1:500 W WASHINGTON AVE STE 220
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-2780
Practice Address - Country:US
Practice Address - Phone:870-919-3230
Practice Address - Fax:870-345-7235
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2025-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR6546-C1041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5MM21OtherBCBS
AR183305795Medicaid
AR183305795Medicaid