Provider Demographics
NPI:1144793555
Name:ODOM, TAYLOR ANNE (RCSWI)
Entity Type:Individual
Prefix:MS
First Name:TAYLOR
Middle Name:ANNE
Last Name:ODOM
Suffix:
Gender:F
Credentials:RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 PENNSYLVANIA AVE APT 107
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-4584
Mailing Address - Country:US
Mailing Address - Phone:904-304-0906
Mailing Address - Fax:
Practice Address - Street 1:1550 S DIXIE HWY STE 203
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3034
Practice Address - Country:US
Practice Address - Phone:786-536-9883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health