Provider Demographics
NPI:1114073830
Name:PENNISSI P. TAYLOR PH.D,PC
Entity Type:Organization
Organization Name:PENNISSI P. TAYLOR PH.D,PC
Other - Org Name:THE TAYLOR CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PENNISSI
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:325-649-4357
Mailing Address - Street 1:PO BOX 1391
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76804-1391
Mailing Address - Country:US
Mailing Address - Phone:325-649-4357
Mailing Address - Fax:325-646-0919
Practice Address - Street 1:205 CENTER AVE.
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-2919
Practice Address - Country:US
Practice Address - Phone:325-649-4357
Practice Address - Fax:325-646-0919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15762103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0007QCOtherBCBS
TX203875OtherVALUE OPTIONS INSURANCE
TX00666UMedicare ID - Type Unspecified
TX0007QCOtherBCBS