Provider Demographics
NPI:1760865307
Name:TAYLOR, LAURA MARIE (BA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 NW 34TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-7302
Mailing Address - Country:US
Mailing Address - Phone:405-850-3776
Mailing Address - Fax:619-374-7134
Practice Address - Street 1:542 NW 34TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-7302
Practice Address - Country:US
Practice Address - Phone:405-850-3776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1-24-71429103K00000X
OKRBT-19-108918106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst