Provider Demographics
NPI:1811274269
Name:TAYLOR, ELIZABETH EVA
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:EVA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 W ROGERS BLVD
Mailing Address - Street 2:P.O. BOX 584
Mailing Address - City:SKIATOOK
Mailing Address - State:OK
Mailing Address - Zip Code:74070-3908
Mailing Address - Country:US
Mailing Address - Phone:918-706-8382
Mailing Address - Fax:
Practice Address - Street 1:2100 W ROGERS BLVD
Practice Address - Street 2:
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070-3908
Practice Address - Country:US
Practice Address - Phone:918-706-8382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional