Provider Demographics
NPI:1639573546
Name:TAYLOR, PAMELA
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 ENGLEWOOD RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-1700
Mailing Address - Country:US
Mailing Address - Phone:941-475-7337
Mailing Address - Fax:941-475-8793
Practice Address - Street 1:2021 ENGLEWOOD RD
Practice Address - Street 2:SUITE D
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-1700
Practice Address - Country:US
Practice Address - Phone:941-475-7337
Practice Address - Fax:941-475-8793
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH12157101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health