Provider Demographics
NPI:1770119950
Name:TAYLOR, SANDRA DEE (MMFT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:DEE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 RIDGLEA DR
Mailing Address - Street 2:
Mailing Address - City:BURNS
Mailing Address - State:TN
Mailing Address - Zip Code:37029-5255
Mailing Address - Country:US
Mailing Address - Phone:932-260-6685
Mailing Address - Fax:
Practice Address - Street 1:318 E COLLEGE ST STE 305
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-1832
Practice Address - Country:US
Practice Address - Phone:931-260-6685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1398106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty