Healthcare Provider Details

I. General information

NPI: 1760689574
Provider Name (Legal Business Name): AVIS M TAYLOR MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 S WASHITA AVE
WYNNEWOOD OK
73098-7820
US

IV. Provider business mailing address

1604 RUSTIC DR
ARDMORE OK
73401-1071
US

V. Phone/Fax

Practice location:
  • Phone: 580-665-4385
  • Fax:
Mailing address:
  • Phone: 580-465-2847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2437
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: