Provider Demographics
NPI:1255620399
Name:TAYLOR, LAURA A (MS)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12081 SW KNIGHTSBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2731
Mailing Address - Country:US
Mailing Address - Phone:561-719-5374
Mailing Address - Fax:772-345-3263
Practice Address - Street 1:12081 SW KNIGHTSBRIDGE LN
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2731
Practice Address - Country:US
Practice Address - Phone:561-719-5374
Practice Address - Fax:772-345-3263
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health