Provider Demographics
NPI:1912768128
Name:TAYLOR, GABRIEL (LPC)
Entity Type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:
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 1:13376 LEHMANN CT
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-4552
Mailing Address - Country:US
Mailing Address - Phone:228-861-2824
Mailing Address - Fax:
Practice Address - Street 1:2620 EXECUTIVE PL
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-3717
Practice Address - Country:US
Practice Address - Phone:228-385-7744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3051101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health