Provider Demographics
NPI:1891229597
Name:TAYLOR, VICTOR (LPC)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2170 THOUSAND OAKS DR
Mailing Address - Street 2:1023Q
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-2553
Mailing Address - Country:US
Mailing Address - Phone:210-632-4927
Mailing Address - Fax:
Practice Address - Street 1:2170 THOUSAND OAKS DR
Practice Address - Street 2:1023Q
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-2553
Practice Address - Country:US
Practice Address - Phone:210-632-4927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74254101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health