MEDICARE: TAYLOR ADDICTION AND WELLNESS, LLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1891224572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAYLOR ADDICTION AND WELLNESS, LLC

Provider Business Mailing Address
First Line	:	5711 LAVENDER ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77026-1725
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5711 LAVENDER ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77026-1725
Country	:	US
Telephone Number	:	713-444-0614
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KRISTI TAYLOR
Credential	:
Telephone Number	:	713-444-0614

Provider Enumeration Date	:	06/07/2017
Last Update Date	:	06/07/2017

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