Provider Demographics
NPI:1568133429
Name:TAYLOR, BRANDON (LPCA)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 S MONROE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-1462
Mailing Address - Country:US
Mailing Address - Phone:270-250-4991
Mailing Address - Fax:
Practice Address - Street 1:933 RUSSELL RD STE 93
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-1054
Practice Address - Country:US
Practice Address - Phone:270-384-1736
Practice Address - Fax:270-384-1734
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY173538101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty