Provider Demographics
NPI:1255102158
Name:HARDY, TAYLOR SHEPHERD (MS, P-LPC)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:SHEPHERD
Last Name:HARDY
Suffix:
Gender:F
Credentials:MS, P-LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 COLONIAL CIR
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-4205
Mailing Address - Country:US
Mailing Address - Phone:703-477-9134
Mailing Address - Fax:
Practice Address - Street 1:1085 STARK RD STE F
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-3682
Practice Address - Country:US
Practice Address - Phone:662-601-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP-1012101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor