Provider Demographics
NPI:1710687264
Name:BOESE, TAYLOR DAWN
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:DAWN
Last Name:BOESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7704 SUNNY POINTE LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-4520
Mailing Address - Country:US
Mailing Address - Phone:580-210-8427
Mailing Address - Fax:
Practice Address - Street 1:416 S MUSTANG RD STE B
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-7314
Practice Address - Country:US
Practice Address - Phone:405-254-7746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor