Provider Demographics
NPI:1770717373
Name:TAYLOR, JUDITH GAIL (LCPC)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:GAIL
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4505 E 47TH ST S
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67210-1651
Mailing Address - Country:US
Mailing Address - Phone:316-529-9100
Mailing Address - Fax:316-529-9351
Practice Address - Street 1:770 S RANGE AVE STE 3
Practice Address - Street 2:
Practice Address - City:COLBY
Practice Address - State:KS
Practice Address - Zip Code:67701-2967
Practice Address - Country:US
Practice Address - Phone:785-443-3460
Practice Address - Fax:785-462-2802
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS130101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health