Individual
JEREMIAH TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
812 OAK ST, CONWAY, AR 72032-4408
(501) 327-7100
(501) 327-7121
Mailing address
812 OAK ST, CONWAY, AR 72032-4408
(501) 279-9000
(501) 279-9011
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0261L
AR
101YP2500X
Professional Counselor
Primary
P1810139
AR
106H00000X
Marriage & Family Therapist
M0708004
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0261L
LICENSED ALCOHOLISM AND DRUG ABUSE COUNSELOR
AR
01
—
M0708004
LMFT
AR
Enumeration date
04/18/2012
Last updated
12/27/2018
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