Provider Demographics
NPI:1700986023
Name:TAYLOR, TRAVIS HENRY III (MA, LPC-MHSP)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:HENRY
Last Name:TAYLOR
Suffix:III
Gender:M
Credentials:MA, LPC-MHSP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 11568
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-0032
Mailing Address - Country:US
Mailing Address - Phone:615-310-6582
Mailing Address - Fax:615-904-6159
Practice Address - Street 1:2690 MEMORIAL BLVD
Practice Address - Street 2:SUITE E4
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-5140
Practice Address - Country:US
Practice Address - Phone:615-310-6582
Practice Address - Fax:615-904-6159
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN000000001453LPC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional