Provider Demographics
NPI:1508453820
Name:TAYLOR, TARA LEE (CDCA)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:LEE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:MS
Other - First Name:TARA
Other - Middle Name:L
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CDCA
Mailing Address - Street 1:149 MERCY BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT ORAB
Mailing Address - State:OH
Mailing Address - Zip Code:45154-0296
Mailing Address - Country:US
Mailing Address - Phone:937-712-3121
Mailing Address - Fax:
Practice Address - Street 1:149 MERCY BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT ORAB
Practice Address - State:OH
Practice Address - Zip Code:45154-0296
Practice Address - Country:US
Practice Address - Phone:937-217-2131
Practice Address - Fax:937-217-3122
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)