Healthcare Provider Details

I. General information

NPI: 1154542272
Provider Name (Legal Business Name): DENETRA TAYLOR M.S., LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DENETRA HOWARD

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 01/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6655 E US HIGHWAY 36
AVON IN
46123-8923
US

IV. Provider business mailing address

5101 E US HIGHWAY 36 STE 100
AVON IN
46123-6646
US

V. Phone/Fax

Practice location:
  • Phone: 888-714-1927
  • Fax: 317-272-0807
Mailing address:
  • Phone: 888-714-1927
  • Fax: 317-745-9565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: