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General NPI Number Information
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NPI Number | 1134799596
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Entity Type | Individual
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Provider Name | KAITLIN TAYLOR M.ED., LPC
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Gender | Female
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Dates
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Enumeration Date | 06/29/2021
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Last Update Date | 07/06/2021
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Provider Practice Location Address
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Address Line | 1271 N MAIN ST
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City | VIDOR
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State | TX
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Zip | 77662-3740
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Country | US
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Telephone | 409-330-0788
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Fax |
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Provider Business Mailing Address
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Address Line | 425 E BOLIVAR ST
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City | VIDOR
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State | TX
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Zip | 77662-5013
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Country | US
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Telephone | 409-330-0788
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 82838
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License Number State | TX
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