Provider Demographics
NPI:1477067296
Name:TAYLOR, KIMBERLY KAYE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:KAYE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96587 OTTER RUN DR
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-1157
Mailing Address - Country:US
Mailing Address - Phone:904-206-1365
Mailing Address - Fax:
Practice Address - Street 1:96587 OTTER RUN DR
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-1157
Practice Address - Country:US
Practice Address - Phone:904-206-1365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9951101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health