Provider Demographics
NPI:1225220858
Name:TAYLOR, LETICIA ANN HOLUB (PHD)
Entity type:Individual
Prefix:DR
First Name:LETICIA
Middle Name:ANN HOLUB
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:TISH
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:12125 HORTON ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2771
Mailing Address - Country:US
Mailing Address - Phone:913-375-6273
Mailing Address - Fax:
Practice Address - Street 1:515 N MUR LEN RD
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1267
Practice Address - Country:US
Practice Address - Phone:913-375-6273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1284103TC2200X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool