Provider Demographics
NPI:1366924375
Name:TAYLOR, DESIREE NICOLE (MS, LPC CANDIDATE)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:NICOLE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS, LPC CANDIDATE
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:NICOLE
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:105 SW BURT ST
Mailing Address - Street 2:
Mailing Address - City:MINCO
Mailing Address - State:OK
Mailing Address - Zip Code:73059-3106
Mailing Address - Country:US
Mailing Address - Phone:405-274-2282
Mailing Address - Fax:
Practice Address - Street 1:7905 E US HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-9225
Practice Address - Country:US
Practice Address - Phone:405-264-5619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor