Provider Demographics
NPI:1679761951
Name:TAYLOR, LAURA C (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:C
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8043 HAVERSHAM WAY
Mailing Address - Street 2:#304
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3096
Mailing Address - Country:US
Mailing Address - Phone:901-756-5483
Mailing Address - Fax:
Practice Address - Street 1:8043 HAVERSHAM WAY
Practice Address - Street 2:# 304
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3096
Practice Address - Country:US
Practice Address - Phone:901-756-5483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490095551041C0700X
TNLSW00000050991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical