Provider Demographics
NPI:1871015487
Name:RUFFIN, TAYLOR BRIANNE
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:BRIANNE
Last Name:RUFFIN
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 1:5131 BUNDY RD APT AA21
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-5387
Mailing Address - Country:US
Mailing Address - Phone:504-813-3524
Mailing Address - Fax:
Practice Address - Street 1:931 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-2400
Practice Address - Country:US
Practice Address - Phone:504-340-8880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health