Provider Demographics
NPI:1922391200
Name:TAYLOR, LAURICE MICHELLE (MA)
Entity Type:Individual
Prefix:
First Name:LAURICE
Middle Name:MICHELLE
Last Name:TAYLOR
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 1:407 COPELAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:64034
Mailing Address - Country:US
Mailing Address - Phone:816-352-7952
Mailing Address - Fax:
Practice Address - Street 1:407 COPELAND DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MO
Practice Address - Zip Code:64034-9350
Practice Address - Country:US
Practice Address - Phone:816-352-7952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011009733101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional