Provider Demographics
NPI:1659020378
Name:TRULL, TAYLOR BROOKE (LCMHC-A)
Entity type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:BROOKE
Last Name:TRULL
Suffix:
Gender:F
Credentials:LCMHC-A
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:BROOKE
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3886 HENDERSON DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-5219
Mailing Address - Country:US
Mailing Address - Phone:910-389-9833
Mailing Address - Fax:
Practice Address - Street 1:3886 HENDERSON DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-5219
Practice Address - Country:US
Practice Address - Phone:910-389-9833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17450101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health