Provider Demographics
NPI:1639919400
Name:QUALLS, TAYLOR (CCHT, RH)
Entity type:Individual
Prefix:MR
First Name:TAYLOR
Middle Name:
Last Name:QUALLS
Suffix:
Gender:X
Credentials:CCHT, RH
Other - Prefix:MR
Other - First Name:GREY
Other - Middle Name:
Other - Last Name:SUN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCHT, RH
Mailing Address - Street 1:2314 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-1109
Mailing Address - Country:US
Mailing Address - Phone:843-694-3616
Mailing Address - Fax:
Practice Address - Street 1:850 TWIN RIVERS DR # PO1930
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43216-9002
Practice Address - Country:US
Practice Address - Phone:740-371-3880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach