Organization Name: | PENNISSI P. TAYLOR PH.D,PC |
NPI Number: | 1114073830 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PENNISSI PATRICK TAYLOR (OWNER) |
Mailing Address: | 205 Center Ave. Brownwood |
State: | TX US |
Postal Code: | 768012919 |
Phone Number: | 3256494357 |
Fax Number: | 3256460919 |
NPI Enumeration Date: | 01/26/2007 |
NPI Last Update Date: | 01/14/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 15762 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |