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General NPI Number Information
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NPI Number | 1831815828
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Entity Type | Individual
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Provider Name | TAYLOR NESBIT LPC ASSOCIATE
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Gender | Male
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Dates
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Enumeration Date | 10/12/2022
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Last Update Date | 10/12/2022
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Provider Practice Location Address
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Address Line | 1825 FORTVIEW RD STE 112
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City | AUSTIN
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State | TX
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Zip | 78704-7657
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Country | US
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Telephone | 512-629-6661
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Fax |
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Provider Business Mailing Address
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Address Line | 150 MAKAHA DR
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City | BASTROP
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State | TX
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Zip | 78602-4701
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Country | US
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Telephone | 512-629-6661
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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 | 90029
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License Number State | TX
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