Provider Demographics
NPI:1922598531
Name:TAYLOR, KALA (PHD, LP-HSP)
Entity Type:Individual
Prefix:DR
First Name:KALA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PHD, LP-HSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 KINGSTON PIKE # 178
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5026
Mailing Address - Country:US
Mailing Address - Phone:865-229-4746
Mailing Address - Fax:865-229-3242
Practice Address - Street 1:5201 KINGSTON PIKE STE 187
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5026
Practice Address - Country:US
Practice Address - Phone:865-229-4746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-18
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11466101Y00000X
TN3655103T00000X, 103TS0200X, 103TC0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q066537Medicaid