Provider Demographics
NPI:1548606247
Name:EDWARD C. TAYLOR, PHD. PL
Entity Type:Organization
Organization Name:EDWARD C. TAYLOR, PHD. PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:904-886-9006
Mailing Address - Street 1:3750 SAN JOSE PL
Mailing Address - Street 2:SUITE 35
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-8858
Mailing Address - Country:US
Mailing Address - Phone:904-886-9006
Mailing Address - Fax:
Practice Address - Street 1:3750 SAN JOSE PL
Practice Address - Street 2:SUITE 35
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-8858
Practice Address - Country:US
Practice Address - Phone:904-886-9006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7903103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty