Provider Demographics
NPI:1912273608
Name:TAYLOR, ANTONIO DEON (LPC)
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:DEON
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3380 WALNUT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-5365
Mailing Address - Country:US
Mailing Address - Phone:931-372-7117
Mailing Address - Fax:931-372-7118
Practice Address - Street 1:3380 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-5365
Practice Address - Country:US
Practice Address - Phone:931-372-7117
Practice Address - Fax:931-372-7119
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TN4020101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health