Provider Demographics
NPI:1871890533
Name:TAYLOR, TINA M (LCSW, LMFT)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9709 FORESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-7403
Mailing Address - Country:US
Mailing Address - Phone:502-797-0936
Mailing Address - Fax:502-749-9224
Practice Address - Street 1:9709 FORESTWOOD DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-7403
Practice Address - Country:US
Practice Address - Phone:502-797-0936
Practice Address - Fax:502-749-9224
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY15011041C0700X
OH06000321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical