MEDICARE: WALTER EARL TAYLOR LCDC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	15909	TX

General Provider Information

NPI Number	:	1518706506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALTER EARL TAYLOR LCDC

Provider Business Mailing Address
First Line	:	PO BOX 1223
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77347-1223
Country	:	US
Telephone Number	:	832-392-4933
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 N SAM HOUSTON PKWY E STE 300
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-4086
Country	:	US
Telephone Number	:	832-392-4933
Fax Number	:

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

Provider Enumeration Date	:	05/21/2024
Last Update Date	:	05/21/2024

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