Provider Demographics
NPI:1174166417
Name:TAYLOR, ALLYSON MARIE (MA, LPA)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:MARIE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MA, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17450 OLD PACIFIC HWY UNIT 12
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97136-9818
Mailing Address - Country:US
Mailing Address - Phone:731-614-8011
Mailing Address - Fax:
Practice Address - Street 1:2507 MAIN AVE N STE B
Practice Address - Street 2:
Practice Address - City:TILLAMOOK
Practice Address - State:OR
Practice Address - Zip Code:97141-9297
Practice Address - Country:US
Practice Address - Phone:503-664-7300
Practice Address - Fax:503-664-7600
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-18
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5063103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist