Healthcare Provider Details

I. General information

NPI: 1649104977
Provider Name (Legal Business Name): TAYLOR DRAPER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 NW 3RD ST
GRAND RAPIDS MN
55744-2135
US

IV. Provider business mailing address

2531 OLD GOLF COURSE RD
GRAND RAPIDS MN
55744-4989
US

V. Phone/Fax

Practice location:
  • Phone: 218-327-2001
  • Fax:
Mailing address:
  • Phone: 562-243-4132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: