Provider Demographics
NPI:1942224704
Name:TAYLOR, JAMES (PHD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 CENTRAL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-5894
Mailing Address - Country:US
Mailing Address - Phone:817-545-8895
Mailing Address - Fax:817-545-8897
Practice Address - Street 1:1912 CENTRAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5894
Practice Address - Country:US
Practice Address - Phone:817-545-8895
Practice Address - Fax:817-545-8897
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22268103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097303402Medicaid
TX00A88LOtherPTAN
TX00A88LMedicare PIN