Provider Demographics
NPI:1578170056
Name:BEVINS, TAYLOR KATHERINE (CDCA)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:KATHERINE
Last Name:BEVINS
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 HYDE PARK DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5840
Mailing Address - Country:US
Mailing Address - Phone:513-567-6895
Mailing Address - Fax:
Practice Address - Street 1:856 HYDE PARK DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-5840
Practice Address - Country:US
Practice Address - Phone:513-567-6895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.173183101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)