Provider Demographics
NPI:1023695004
Name:TAYLOR MADE COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:TAYLOR MADE COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TUSHONDA
Authorized Official - Middle Name:FLEETON
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:228-760-0262
Mailing Address - Street 1:PO BOX 6771
Mailing Address - Street 2:
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-6771
Mailing Address - Country:US
Mailing Address - Phone:228-760-0262
Mailing Address - Fax:
Practice Address - Street 1:232 EISENHOWER DR STE B
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-3601
Practice Address - Country:US
Practice Address - Phone:601-688-4118
Practice Address - Fax:228-220-4226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-26
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty