Provider Demographics
NPI:1801139076
Name:TAYLOR, ANDREW LEE (BA, CADC)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:LEE
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:BA, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1728 CENTRAL AVE
Mailing Address - Street 2:STE 6
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-4200
Mailing Address - Country:US
Mailing Address - Phone:515-302-8025
Mailing Address - Fax:515-302-8035
Practice Address - Street 1:1728 CENTRAL AVE
Practice Address - Street 2:STE 6
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4200
Practice Address - Country:US
Practice Address - Phone:515-302-8025
Practice Address - Fax:515-302-8035
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1346101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor