Provider Demographics
NPI:1922886290
Name:BURCH, TAYLOR (MC61461259)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:BURCH
Suffix:
Gender:F
Credentials:MC61461259
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 E GRAHAM ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-6008
Mailing Address - Country:US
Mailing Address - Phone:704-917-8814
Mailing Address - Fax:
Practice Address - Street 1:826 E GRAHAM ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-6008
Practice Address - Country:US
Practice Address - Phone:704-917-8814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMC61461259101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health