MEDICARE: TARA TAYLOR 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	103K00000X	Behavior Analyst	1-13-13386	TX

General Provider Information

NPI Number	:	1740691658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA TAYLOR BCBA

Provider Business Mailing Address
First Line	:	19019 VENTURA BLVD
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91356-3253
Country	:	US
Telephone Number	:	818-345-2345
Fax Number	:	818-758-8015

Provider Business Practice Location Address
First Line	:	9390 RESEARCH BLVD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-6585
Country	:	US
Telephone Number	:	512-330-9520
Fax Number	:	512-330-9505

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

Provider Enumeration Date	:	05/13/2014
Last Update Date	:	05/13/2014

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