Healthcare Provider Details

I. General information

NPI: 1013796440
Provider Name (Legal Business Name): TAYLOR N MASHAW LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 02/15/2026
Certification Date: 02/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 BURGESSVILLE RD
RUSTON LA
71270-5154
US

IV. Provider business mailing address

115 BAYWOOD LN
RUSTON LA
71270-5672
US

V. Phone/Fax

Practice location:
  • Phone: 318-225-7223
  • Fax: 318-415-1004
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8624
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8624
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: