Provider Demographics
NPI:1861545493
Name:TAYLOR, JOHN FREDERICK (PHD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:FREDERICK
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:488 GLACIER WAY S
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH
Mailing Address - State:OR
Mailing Address - Zip Code:97361-1768
Mailing Address - Country:US
Mailing Address - Phone:503-606-4233
Mailing Address - Fax:503-838-1608
Practice Address - Street 1:488 GLACIER WAY S
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:OR
Practice Address - Zip Code:97361-1768
Practice Address - Country:US
Practice Address - Phone:503-606-4233
Practice Address - Fax:503-838-1608
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR290103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical