Provider Demographics
NPI:1740545425
Name:STACY TAYLOR, INC.
Entity type:Organization
Organization Name:STACY TAYLOR, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:LOREN
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:407-375-8176
Mailing Address - Street 1:PO BOX 623777
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32762-3777
Mailing Address - Country:US
Mailing Address - Phone:407-375-8176
Mailing Address - Fax:888-277-8904
Practice Address - Street 1:2695 CYPRESS HEAD TRL
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-7381
Practice Address - Country:US
Practice Address - Phone:407-375-8176
Practice Address - Fax:888-277-8904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health