Provider Demographics
NPI:1326644881
Name:TAYLOR, JESSICA M (MA, IMHC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:M
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MA, IMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 LUNA BELLA LN APT 323
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-4684
Mailing Address - Country:US
Mailing Address - Phone:510-334-7319
Mailing Address - Fax:
Practice Address - Street 1:136 JULIA ST
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7713
Practice Address - Country:US
Practice Address - Phone:386-423-9161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH20129101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health