Provider Demographics
NPI:1821014911
Name:TAYLOR, PAMELA S (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:S
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2413 MAIN ST # 518
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-7809
Mailing Address - Country:US
Mailing Address - Phone:816-739-7102
Mailing Address - Fax:866-635-0971
Practice Address - Street 1:17115 SW 49TH PL
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4919
Practice Address - Country:US
Practice Address - Phone:816-340-6649
Practice Address - Fax:866-635-0971
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
MO1999137748101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO494665540Medicaid