MEDICARE: MS. TRUDI Y. TAYLOR PH.D

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	101Y00000X	Counselor	759	NC
2	101Y00000X	Counselor	80848	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	81869	OTHER	NC	BC/BS PROVIDER NUMBER

General Provider Information

NPI Number	:	1851379697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRUDI Y. TAYLOR PH.D

Provider Business Mailing Address
First Line	:	9274 PARK GARDEN DR
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75035-3167
Country	:	US
Telephone Number	:	919-272-1888
Fax Number	:

Provider Business Practice Location Address
First Line	:	8105 RASOR BLVD STE 117
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-0118
Country	:	US
Telephone Number	:	919-272-1888
Fax Number	:

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

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	03/24/2021

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