Provider Demographics
NPI:1689968257
Name:TAYLOR, AMELIA M (MA)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:M
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E BUTLER ST
Mailing Address - Street 2:
Mailing Address - City:MERCER
Mailing Address - State:PA
Mailing Address - Zip Code:16137-1116
Mailing Address - Country:US
Mailing Address - Phone:724-558-5063
Mailing Address - Fax:
Practice Address - Street 1:1246 ROEMER BLVD
Practice Address - Street 2:
Practice Address - City:FARRELL
Practice Address - State:PA
Practice Address - Zip Code:16121-1734
Practice Address - Country:US
Practice Address - Phone:724-558-5063
Practice Address - Fax:724-662-7208
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PC007543101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health