Provider Demographics
NPI:1962814723
Name:TAYLOR, ANGELA KAY (MS, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:KAY
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 6TH AVE S STE B
Mailing Address - Street 2:
Mailing Address - City:PAYETTE
Mailing Address - State:ID
Mailing Address - Zip Code:83661-3520
Mailing Address - Country:US
Mailing Address - Phone:208-834-1112
Mailing Address - Fax:208-741-6667
Practice Address - Street 1:846 6TH AVE S STE B
Practice Address - Street 2:
Practice Address - City:PAYETTE
Practice Address - State:ID
Practice Address - Zip Code:83661-3520
Practice Address - Country:US
Practice Address - Phone:208-834-1112
Practice Address - Fax:208-741-6667
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
ORLPC-7375101YP2500X
IDLPC-5686101YP2500X
IDLCPC-8553101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional