Provider Demographics
NPI:1790534071
Name:TAYLOR, JONAH
Entity type:Individual
Prefix:
First Name:JONAH
Middle Name:
Last Name:TAYLOR
Suffix:
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 1:15044 SADDLE RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-1082
Mailing Address - Country:US
Mailing Address - Phone:469-318-8671
Mailing Address - Fax:
Practice Address - Street 1:15044 SADDLE RIDGE CIR
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-1082
Practice Address - Country:US
Practice Address - Phone:469-318-8671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst