Provider Demographics
NPI:1558839233
Name:CLAYTON, TAYLOR (RBT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 GULF BREEZE PKWY
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-3350
Mailing Address - Country:US
Mailing Address - Phone:800-676-5130
Mailing Address - Fax:888-958-5753
Practice Address - Street 1:645 BALTIMORE ANNAPOLIS BLVD STE 216-217
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3931
Practice Address - Country:US
Practice Address - Phone:800-676-5130
Practice Address - Fax:888-958-5753
Is Sole Proprietor?:No
Enumeration Date:2018-11-11
Last Update Date:2018-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC-435-785-488-381OtherDRIVER'S LICENSE