Provider Demographics
NPI:1538815675
Name:EWING, TAYLOR (MA, NCC, LCPC)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:EWING
Suffix:
Gender:F
Credentials:MA, NCC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 EMERY DR
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1009
Mailing Address - Country:US
Mailing Address - Phone:815-549-6144
Mailing Address - Fax:
Practice Address - Street 1:755 ALMAR PKWY
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2392
Practice Address - Country:US
Practice Address - Phone:779-229-6581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.017662101YP2500X
IL180.016013101YP2500X
IL180016013101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional