Provider Demographics
NPI:1578104725
Name:JENNIFER JO TAYLOR LLC
Entity Type:Organization
Organization Name:JENNIFER JO TAYLOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JO
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:256-651-2413
Mailing Address - Street 1:192 MINNIE BROWN RD
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:TN
Mailing Address - Zip Code:38449-3040
Mailing Address - Country:US
Mailing Address - Phone:256-651-2413
Mailing Address - Fax:
Practice Address - Street 1:200 RUSSELL ST NE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3602
Practice Address - Country:US
Practice Address - Phone:256-651-2413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1003175100OtherNPI