MEDICARE: WENDY TAYLOR LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MT 3121	FL

General Provider Information

NPI Number	:	1013374412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY TAYLOR LMFT

Provider Business Mailing Address
First Line	:	33211 KAYLEE WAY
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34788-3831
Country	:	US
Telephone Number	:	352-501-8210
Fax Number	:	407-867-6316

Provider Business Practice Location Address
First Line	:	4400 N HIGHWAY 19A
Second Line	:	SUITE 5
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-2032
Country	:	US
Telephone Number	:	352-315-7800
Fax Number	:	352-315-7587

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2016
Last Update Date	:	11/08/2016

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Directions to “ WENDY TAYLOR LMFT” Practice Location

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