Provider Demographics
NPI:1669512166
Name:TAYLOR, LINDA LOU (LPC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LOU
Last Name:TAYLOR
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 1:423 E LOGAN ST
Mailing Address - Street 2:ROOM 100
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-2222
Mailing Address - Country:US
Mailing Address - Phone:660-676-0379
Mailing Address - Fax:
Practice Address - Street 1:423 E LOGAN ST
Practice Address - Street 2:ROOM 100
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-2222
Practice Address - Country:US
Practice Address - Phone:660-676-0379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004024775101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional