Healthcare Provider Details

I. General information

NPI: 1619593076
Provider Name (Legal Business Name): TAYLOR ROBERSON MED, EDS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E ALPINE ST STE 22B
SILOAM SPRINGS AR
72761-3199
US

IV. Provider business mailing address

105 E ALPINE ST # B-22
SILOAM SPRINGS AR
72761-3164
US

V. Phone/Fax

Practice location:
  • Phone: 479-351-0023
  • Fax:
Mailing address:
  • Phone: 479-351-0023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP2309001
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2309001
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0016359
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0016359
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: