Provider Demographics
NPI:1265810501
Name:TAYLOR, BRYAN (LSSP, LPC-S)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LSSP, LPC-S
Other - Prefix:
Other - First Name:BYRON
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1731
Mailing Address - Street 2:
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-7731
Mailing Address - Country:US
Mailing Address - Phone:830-693-0530
Mailing Address - Fax:830-637-7438
Practice Address - Street 1:606 AVENUE J
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-5146
Practice Address - Country:US
Practice Address - Phone:830-693-0530
Practice Address - Fax:830-637-7438
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9922101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional