MEDICARE: DR. JO LASHAWN TAYLOR-CLARK PSY.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	JC860064	LA

General Provider Information

NPI Number	:	1053174623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JO LASHAWN TAYLOR-CLARK PSY.D

Provider Business Mailing Address
First Line	:	1707 MARY LOU DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70810-1450
Country	:	US
Telephone Number	:	225-877-0829
Fax Number	:

Provider Business Practice Location Address
First Line	:	1707 MARY LOU DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70810-1450
Country	:	US
Telephone Number	:	225-877-0829
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2024
Last Update Date	:	02/05/2024

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