Provider Demographics
NPI:1770672941
Name:TAYLOR, TERRI (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1789 WOODLANE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-3910
Mailing Address - Country:US
Mailing Address - Phone:651-739-7539
Mailing Address - Fax:651-730-9200
Practice Address - Street 1:1789 WOODLANE DR
Practice Address - Street 2:SUITE C
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-3910
Practice Address - Country:US
Practice Address - Phone:651-739-7539
Practice Address - Fax:651-730-9200
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1430106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist