Provider Demographics
NPI:1790477255
Name:TAYLOR, JAMES MAX JR (LCDC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MAX
Last Name:TAYLOR
Suffix:JR
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 MOLINE CIR
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-2192
Mailing Address - Country:US
Mailing Address - Phone:254-462-5269
Mailing Address - Fax:
Practice Address - Street 1:4520 E CENTRAL TEXAS EXPY
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-5626
Practice Address - Country:US
Practice Address - Phone:254-299-2787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)