Provider Demographics
NPI:1770590309
Name:TAYLOR, MARTHA JO (LPC & LMFT)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:JO
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPC & LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3102 STONEHENGE LN
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-5214
Mailing Address - Country:US
Mailing Address - Phone:972-416-7685
Mailing Address - Fax:
Practice Address - Street 1:3102 STONEHENGE LN
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-5214
Practice Address - Country:US
Practice Address - Phone:972-488-2533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12833101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health