MEDICARE: AMANDA TAYLOR

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1215397922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA TAYLOR

Provider Business Mailing Address
First Line	:	1713 GENERAL MOUTON AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70810-6818
Country	:	US
Telephone Number	:	225-287-3791
Fax Number	:

Provider Business Practice Location Address
First Line	:	4348 S JEFFREY DR STE 102
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816
Country	:	US
Telephone Number	:	225-361-0219
Fax Number	:

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

Provider Enumeration Date	:	02/24/2016
Last Update Date	:	11/24/2023

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