Healthcare Provider Details

I. General information

NPI: 1871327072
Provider Name (Legal Business Name): BYRON DOMINIC TAYLOR LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 BEAUVOIR RD STE 100 #5192
BILOXI MS
39531-4052
US

IV. Provider business mailing address

296 BEAUVOIR RD STE 100 #5192
BILOXI MS
39531-4052
US

V. Phone/Fax

Practice location:
  • Phone: 228-229-9239
  • Fax:
Mailing address:
  • Phone: 228-229-9239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0022092
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberTEL1036
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3129
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: