Provider Demographics
NPI:1710004874
Name:TAYLOR, HEIDI ANN (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:ANN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 PEACOCK LN
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-2417
Mailing Address - Country:US
Mailing Address - Phone:304-680-3377
Mailing Address - Fax:
Practice Address - Street 1:3040 UNIVERSITY AVE
Practice Address - Street 2:SUITE 3376
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3380
Practice Address - Country:US
Practice Address - Phone:304-291-2446
Practice Address - Fax:304-598-2777
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1555101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional