Healthcare Provider Details

I. General information

NPI: 1851934251
Provider Name (Legal Business Name): TAYLOR WISEMAN BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2019
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 BROOKS INDUSTRIAL RD
SHELBYVILLE KY
40065-8154
US

IV. Provider business mailing address

2390 WOODLAWN RD
SHELBYVILLE KY
40065-9377
US

V. Phone/Fax

Practice location:
  • Phone: 502-633-1315
  • Fax:
Mailing address:
  • Phone: 502-220-5432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number268793
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: