Provider Demographics
NPI:1447669874
Name:TAYLOR, NICHOLAS DALE (PHD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:DALE
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8701 SHOAL CREEK BLVD STE 404
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-6809
Mailing Address - Country:US
Mailing Address - Phone:513-813-0640
Mailing Address - Fax:
Practice Address - Street 1:8701 SHOAL CREEK BLVD STE 404
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-6809
Practice Address - Country:US
Practice Address - Phone:513-813-0640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2022-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX38203103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX38203OtherSTATE PSYCHOLOGY PRACTICE LICENSE