1992133458 NPI number — AMANDA BATES TAYLOR LCSW, CSOTP

Table of content: AMANDA BATES TAYLOR LCSW, CSOTP (NPI 1992133458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992133458 NPI number — AMANDA BATES TAYLOR LCSW, CSOTP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAYLOR
Provider First Name:
AMANDA
Provider Middle Name:
BATES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW, CSOTP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BATES
Provider Other First Name:
AMANDA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992133458
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/26/2019
NPI Reactivation Date:
08/13/2019

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
143 RIDGEWAY DR STE 111
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70503-3495
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-366-0896
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
143 RIDGEWAY DR STE 111
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70503-3495
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-366-0896
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/21/2013

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: 1041C0700X , with the licence number:  12239 , 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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