Provider Demographics
NPI:1194850370
Name:TAYLOR, PENNISSI P (PHD)
Entity Type:Individual
Prefix:DR
First Name:PENNISSI
Middle Name:P
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 AVENUE
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15762103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203875OtherVALUE OPTIONS
TX87411AOtherBCBS
TXS42212Medicare UPIN
TX8A3095Medicare ID - Type UnspecifiedPERFORMING PROVIDER