Provider Demographics
NPI:1972827939
Name:TAYLOR, JENNIFER DELAINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:DELAINE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:DELAINE
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:349 KELLER PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-2266
Mailing Address - Country:US
Mailing Address - Phone:817-382-2249
Mailing Address - Fax:817-541-4483
Practice Address - Street 1:349 KELLER PKWY STE 100
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-2266
Practice Address - Country:US
Practice Address - Phone:817-382-2249
Practice Address - Fax:817-541-4483
Is Sole Proprietor?:No
Enumeration Date:2010-03-19
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099230501041C0700X
TX629841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical