Provider Demographics
NPI:1356067698
Name:FRISTOE, TAYLOR (MSW, LSW)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:FRISTOE
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 PERCHERON PL
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-2607
Mailing Address - Country:US
Mailing Address - Phone:765-714-0083
Mailing Address - Fax:
Practice Address - Street 1:114 EXECUTIVE DR STE E
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4875
Practice Address - Country:US
Practice Address - Phone:765-714-0083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor