Healthcare Provider Details

I. General information

NPI: 1366924375
Provider Name (Legal Business Name): DESIREE TAYLOR LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DESIREE GRAHAM LPC

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 N PENIEL AVE
BETHANY OK
73008-3443
US

IV. Provider business mailing address

105 SW BURT ST
MINCO OK
73059-3106
US

V. Phone/Fax

Practice location:
  • Phone: 405-256-3355
  • Fax:
Mailing address:
  • Phone: 405-274-2282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: