MEDICARE: TAYLOR LOUCKS BCBA

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	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1396251856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR LOUCKS BCBA

Provider Business Mailing Address
First Line	:	3107 W COLORADO AVE # 118
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-2040
Country	:	US
Telephone Number	:	720-563-1736
Fax Number	:

Provider Business Practice Location Address
First Line	:	2822 W CUCHARRAS ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-2448
Country	:	US
Telephone Number	:	720-563-1736
Fax Number	:

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

Provider Enumeration Date	:	12/20/2017
Last Update Date	:	04/24/2024

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Directions to “ TAYLOR LOUCKS BCBA” Practice Location

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