Provider Demographics
NPI:1982220380
Name:IRVINE, TAYLOR (RMHCI)
Entity Type:Individual
Prefix:MS
First Name:TAYLOR
Middle Name:
Last Name:IRVINE
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:MS
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:IRVINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TAYLOR IRVINE
Mailing Address - Street 1:7700 RENFREW LN
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3508
Mailing Address - Country:US
Mailing Address - Phone:954-594-0565
Mailing Address - Fax:
Practice Address - Street 1:7700 RENFREW LN
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-3508
Practice Address - Country:US
Practice Address - Phone:954-594-0565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18378101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health