Provider Demographics
NPI:1720568595
Name:ISLEY-CLARK, TAYLOR (LPC)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:ISLEY-CLARK
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 1:45 E CITY AVE UNIT 777
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2421
Mailing Address - Country:US
Mailing Address - Phone:267-819-4308
Mailing Address - Fax:
Practice Address - Street 1:2834 N VAN PELT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19132-2643
Practice Address - Country:US
Practice Address - Phone:267-819-4308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
252Y00000X
PAPC013663101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No252Y00000XAgenciesEarly Intervention Provider Agency