Provider Demographics
NPI:1659434983
Name:TAYLOR, JAMIE R (LPCC)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:R
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3027 DIAMANTES NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1541
Mailing Address - Country:US
Mailing Address - Phone:505-839-9863
Mailing Address - Fax:
Practice Address - Street 1:3027 DIAMANTES NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1541
Practice Address - Country:US
Practice Address - Phone:505-839-9863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3458101YA0400X
NM0058001101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional