Provider Demographics
NPI:1861824997
Name:TAYLOR, LISA CAROL (MED, MPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:CAROL
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MED, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 S GARNETT RD STE G
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74128-1838
Mailing Address - Country:US
Mailing Address - Phone:918-878-7877
Mailing Address - Fax:918-878-7882
Practice Address - Street 1:2001 S GARNETT RD STE G
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74128-1838
Practice Address - Country:US
Practice Address - Phone:918-878-7877
Practice Address - Fax:918-878-7882
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health