Provider Demographics
NPI:1831670959
Name:CLARE TAYLOR COUNSELING PLLC
Entity type:Organization
Organization Name:CLARE TAYLOR COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CLARE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-MHSP
Authorized Official - Phone:931-553-3029
Mailing Address - Street 1:119 N 3RD ST OFC 24
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-3401
Mailing Address - Country:US
Mailing Address - Phone:931-553-3029
Mailing Address - Fax:931-241-5406
Practice Address - Street 1:119 N 3RD ST OFC 24
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3401
Practice Address - Country:US
Practice Address - Phone:931-553-3029
Practice Address - Fax:931-241-5406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-27
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ044025Medicaid