Healthcare Provider Details

I. General information

NPI: 1821469743
Provider Name (Legal Business Name): TAMERA TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2015
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CENTURY VILLAGE BLVD STE 234
MONROE LA
71203-2008
US

IV. Provider business mailing address

201 CENTURY VILLAGE BLVD STE 234
MONROE LA
71203-2008
US

V. Phone/Fax

Practice location:
  • Phone: 318-914-2632
  • Fax: 318-855-3998
Mailing address:
  • Phone: 318-692-0225
  • Fax: 318-855-3993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5045
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: