1700986023 NPI number — MR. TRAVIS HENRY TAYLOR III MA, LPC-MHSP

Table of content: MR. TRAVIS HENRY TAYLOR III MA, LPC-MHSP (NPI 1700986023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700986023 NPI number — MR. TRAVIS HENRY TAYLOR III MA, LPC-MHSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAYLOR
Provider First Name:
TRAVIS
Provider Middle Name:
HENRY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
III
Provider Credential Text:
MA, LPC-MHSP
Provider Gender Code:
M

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:
1700986023
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11568
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURFREESBORO
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37129-0032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-310-6582
Provider Business Mailing Address Fax Number:
615-904-6159

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2690 MEMORIAL BLVD
Provider Second Line Business Practice Location Address:
SUITE E4
Provider Business Practice Location Address City Name:
MURFREESBORO
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37129-5140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-310-6582
Provider Business Practice Location Address Fax Number:
615-904-6159
Provider Enumeration Date:
09/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  000000001453LPC , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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