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Individual
LARRY TAYLOR
Active
Individual
LARRY TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRM/PSS/QMHA-I
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15-CRM-017
OR
101YM0800X
Mental Health Counselor
19-QMHA-I-00478
OR
175T00000X
Peer Specialist
THW000002408
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500743133
—
OR
05
—
500760853
—
OR
Enumeration date
04/27/2018
Last updated
04/17/2019
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