Provider Demographics
NPI:1942686662
Name:TAYLOR, EDDIE SR
Entity Type:Individual
Prefix:
First Name:EDDIE
Middle Name:
Last Name:TAYLOR
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5513 N UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74130-1724
Mailing Address - Country:US
Mailing Address - Phone:918-237-0155
Mailing Address - Fax:
Practice Address - Street 1:5513 N UTICA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74130-1724
Practice Address - Country:US
Practice Address - Phone:918-237-0155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor