Provider Demographics
NPI:1871338012
Name:DENNIS, TAYLOR RAYE (LMHC)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:RAYE
Last Name:DENNIS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 W 1ST ST APT A
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-5916
Mailing Address - Country:US
Mailing Address - Phone:575-815-9282
Mailing Address - Fax:
Practice Address - Street 1:100 S AVENUE A STE B7
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-5917
Practice Address - Country:US
Practice Address - Phone:575-815-9282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2024-0173101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health