Individual
JACK KENNEDY TAYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
19971 FM 3175, LYTLE, TX 78052-3481
(512) 755-0521
Mailing address
PO BOX 1262, LYTLE, TX 78052-1262
(512) 755-0521
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
87648
TX
Other
Enumeration date
11/08/2023
Last updated
11/08/2023
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