Provider Demographics
NPI:1760811137
Name:TAYLOR, KENNETH R (LPC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:R
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2277 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-4713
Mailing Address - Country:US
Mailing Address - Phone:888-796-1117
Mailing Address - Fax:803-996-5228
Practice Address - Street 1:2277 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4713
Practice Address - Country:US
Practice Address - Phone:888-796-1117
Practice Address - Fax:803-996-5228
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC 1596Medicaid