1063992485 NPI number — TAYLOR DRAUGHN COUNSELING, LLC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063992485 NPI number — TAYLOR DRAUGHN COUNSELING, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAYLOR DRAUGHN COUNSELING, LLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063992485
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
114 TEAL LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST MONROE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71291-9167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-614-5247
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 LINCOLN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71291-4510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-600-5641
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2018

Additional Information

Authorized Official

Authorized Official Last Name:
DRAUGHN
Authorized Official First Name:
TARAH
Authorized Official Middle Name:
TAYLOR
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
318-600-5641

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  5317 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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