Doctor Name: | JESSICA TAYLOR |
NPI Number: | 1083842017 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 2008023818 |
Business Practice Address: | 2705 Mullanphy Ln Florissant, MO - 630313727 |
Business Phone Number: | 3148371702 |
Business Fax Number: | 3148306257 |
Mailing Address: | 2705 Mullanphy Ln, FLORISSANT |
State: | MO |
Postal Code: | 630313727 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 06/29/2009 |
NPI Last Update Date: | 06/29/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 2008023818 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |