Provider Demographics
NPI:1568997138
Name:PERDUE, TAYLOR FAIR (LPC)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:FAIR
Last Name:PERDUE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3768 CRESTBROOK RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35223-1556
Mailing Address - Country:US
Mailing Address - Phone:256-591-1153
Mailing Address - Fax:
Practice Address - Street 1:2127 14TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-3900
Practice Address - Country:US
Practice Address - Phone:256-591-1153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3513101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor