Healthcare Provider Details

I. General information

NPI: 1730978818
Provider Name (Legal Business Name): AUSTIN JAMES TAYLOR LPC-IT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 CHEYENNE AVE STE 200
GRAFTON WI
53024-9323
US

IV. Provider business mailing address

1410 W SUNSET RD APT 105
PORT WASHINGTON WI
53074-2452
US

V. Phone/Fax

Practice location:
  • Phone: 855-607-8242
  • Fax:
Mailing address:
  • Phone: 608-635-5336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8226-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: