Provider Demographics
NPI:1942032404
Name:TAYLOR, DIANE LAVERN (PHD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:LAVERN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3660 CEDAR PINE PL
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46235-5812
Mailing Address - Country:US
Mailing Address - Phone:317-833-7413
Mailing Address - Fax:
Practice Address - Street 1:3660 CEDAR PINE PL
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46235-5812
Practice Address - Country:US
Practice Address - Phone:317-833-7413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty