Individual
AMANDA TAYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
406 RAYBURN RD, CARRIERE, MS 39426-8381
(601) 590-6526
Mailing address
300 MARINERS PLAZA DR, MANDEVILLE, LA 70448-6828
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669881173
—
LA
Enumeration date
06/06/2017
Last updated
06/06/2017
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