Provider Demographics
NPI:1750856977
Name:TAYLOR, JAMILLE (BS)
Entity Type:Individual
Prefix:
First Name:JAMILLE
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5170 E 65TH ST STE 106
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-4992
Mailing Address - Country:US
Mailing Address - Phone:317-525-3211
Mailing Address - Fax:
Practice Address - Street 1:5170 E 65TH ST STE 106
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4992
Practice Address - Country:US
Practice Address - Phone:317-986-6755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health