Provider Demographics
NPI:1679257182
Name:WACHTARZ, TAYLOR NICOLE (LPC)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:NICOLE
Last Name:WACHTARZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 GOSHEN RD
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06759-2405
Mailing Address - Country:US
Mailing Address - Phone:860-756-5153
Mailing Address - Fax:860-567-2669
Practice Address - Street 1:52 PECK RD
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6107
Practice Address - Country:US
Practice Address - Phone:860-964-5690
Practice Address - Fax:860-618-2824
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6468101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health