Provider Demographics
NPI:1164010930
Name:THOMAS, TAYLOR LEA (CBHCMS 100732)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LEA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CBHCMS 100732
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 WILLOW CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33898-7029
Mailing Address - Country:US
Mailing Address - Phone:863-254-8665
Mailing Address - Fax:
Practice Address - Street 1:2601 WILLOW CIR
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33898-7029
Practice Address - Country:US
Practice Address - Phone:863-254-8665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management