Provider Demographics
NPI:1518706506
Name:TAYLOR, WALTER EARL (LCDC)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:EARL
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1223
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77347-1223
Mailing Address - Country:US
Mailing Address - Phone:832-392-4933
Mailing Address - Fax:
Practice Address - Street 1:505 N SAM HOUSTON PKWY E STE 300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-4086
Practice Address - Country:US
Practice Address - Phone:832-392-4933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15909101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)