Provider Demographics
NPI:1821469743
Name:TAYLOR, TAMERA
Entity Type:Individual
Prefix:
First Name:TAMERA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 CENTURY VILLAGE BLVD STE 234
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2008
Mailing Address - Country:US
Mailing Address - Phone:318-692-0225
Mailing Address - Fax:318-855-3993
Practice Address - Street 1:201 CENTURY VILLAGE BLVD STE 234
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2008
Practice Address - Country:US
Practice Address - Phone:318-914-2632
Practice Address - Fax:318-855-3998
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
LA5045101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator