Provider Demographics
NPI:1235537416
Name:JENNIFER TAYLOR PLAY THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:JENNIFER TAYLOR PLAY THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:901-579-0242
Mailing Address - Street 1:879 WILLOW TREE CIR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-3121
Mailing Address - Country:US
Mailing Address - Phone:901-579-0242
Mailing Address - Fax:901-328-6309
Practice Address - Street 1:879 WILLOW TREE CIR
Practice Address - Street 2:SUITE 102
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-3121
Practice Address - Country:US
Practice Address - Phone:901-579-0242
Practice Address - Fax:901-328-6309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6000251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health