Basic Information
| Provider Information | |||||||||
| NPI: | 1457774127 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | |||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2580 LIN DO CT | ||||||||
| Address2: | |||||||||
| City: | SUMTER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291501832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8039054427 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2580 LIN DO CT | ||||||||
| Address2: | |||||||||
| City: | SUMTER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291501832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8039054427 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2014 | ||||||||
| LastUpdateDate: | 06/27/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | BCBA: 1-14-15907 | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.