Provider Demographics
NPI:1053174623
Name:TAYLOR-CLARK, JO LASHAWN (PSYD)
Entity type:Individual
Prefix:DR
First Name:JO LASHAWN
Middle Name:
Last Name:TAYLOR-CLARK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 MARY LOU DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1450
Mailing Address - Country:US
Mailing Address - Phone:225-877-0829
Mailing Address - Fax:
Practice Address - Street 1:1707 MARY LOU DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1450
Practice Address - Country:US
Practice Address - Phone:225-877-0829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAJC860064103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty