Provider Demographics
NPI:1033886106
Name:NICHOLS, TAYLOR SHAELYNN
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:SHAELYNN
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4647 LINDEN PL
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-8673
Mailing Address - Country:US
Mailing Address - Phone:860-877-5689
Mailing Address - Fax:
Practice Address - Street 1:4638 RIVERSTONE BLVD
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-6157
Practice Address - Country:US
Practice Address - Phone:281-969-7527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst