Healthcare Provider Details

I. General information

NPI: 1205059532
Provider Name (Legal Business Name): TIMOTHY NEAL TAYLOR MS ED., LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 04/23/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 S MATTIS AVE
CHAMPAIGN IL
61821-5923
US

IV. Provider business mailing address

611 W PARK FAPC
CHAMPAIGN IL
61801
US

V. Phone/Fax

Practice location:
  • Phone: 217-383-1850
  • Fax: 217-383-3439
Mailing address:
  • Phone: 217-902-6954
  • Fax: 217-902-7711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180005526
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180-005526
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: