Provider Demographics
NPI:1871327072
Name:TAYLOR, BYRON DOMINIC (LPC)
Entity type:Individual
Prefix:
First Name:BYRON
Middle Name:DOMINIC
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 BEAUVOIR RD STE 100
Mailing Address - Street 2:#5192
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-4052
Mailing Address - Country:US
Mailing Address - Phone:228-229-9239
Mailing Address - Fax:
Practice Address - Street 1:296 BEAUVOIR RD STE 100
Practice Address - Street 2:#5192
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4052
Practice Address - Country:US
Practice Address - Phone:228-229-9239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3129101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional