Provider Demographics
NPI:1891313995
Name:SPELL, TAYLOR LEIGH (MA)
Entity Type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:LEIGH
Last Name:SPELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 LONGTOWN RD W
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-8184
Mailing Address - Country:US
Mailing Address - Phone:803-920-8834
Mailing Address - Fax:
Practice Address - Street 1:3924 FOREST DR STE 3
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4148
Practice Address - Country:US
Practice Address - Phone:803-258-0533
Practice Address - Fax:803-929-7944
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRBT-18-52654106S00000X
SC1-23-64496103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician