Provider Demographics
NPI:1699208405
Name:TAYLOR, ANTHONY L SR
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:L
Last Name:TAYLOR
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 S MINGO RD APT 2502
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-0842
Mailing Address - Country:US
Mailing Address - Phone:404-542-2357
Mailing Address - Fax:
Practice Address - Street 1:8001 S MINGO RD APT 2502
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-0842
Practice Address - Country:US
Practice Address - Phone:404-542-2357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician