Provider Demographics
NPI:1598075129
Name:TAYLOR, CLIFTON NELSON (LPC)
Entity Type:Individual
Prefix:MR
First Name:CLIFTON
Middle Name:NELSON
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13837 BROOK HOLLOW BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4701
Mailing Address - Country:US
Mailing Address - Phone:210-378-0480
Mailing Address - Fax:210-231-0832
Practice Address - Street 1:12915 JONES MALTSBERGER ROAD
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247
Practice Address - Country:US
Practice Address - Phone:210-378-0480
Practice Address - Fax:210-231-0832
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-17
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65007101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional