Provider Demographics
NPI:1548775760
Name:TAYLOR, MEGAN MARIE (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MA, BCBA
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 362
Mailing Address - Street 2:
Mailing Address - City:TRIPOLI
Mailing Address - State:IA
Mailing Address - Zip Code:50676-0362
Mailing Address - Country:US
Mailing Address - Phone:978-408-8425
Mailing Address - Fax:
Practice Address - Street 1:1320 WALNUT ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-3931
Practice Address - Country:US
Practice Address - Phone:812-478-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2023-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-20-42597103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst