Provider Demographics
NPI:1750698379
Name:TAYLOR, WILLIE MORRIS III
Entity type:Individual
Prefix:MR
First Name:WILLIE
Middle Name:MORRIS
Last Name:TAYLOR
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5173 1/2 PICKFORD ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-5302
Mailing Address - Country:US
Mailing Address - Phone:323-775-8645
Mailing Address - Fax:
Practice Address - Street 1:1926 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2402
Practice Address - Country:US
Practice Address - Phone:213-353-1140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health