MEDICARE: EDWARD V TAYLOR SR.

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	101YM0800X	Mental Health Counselor		OK

General Provider Information

NPI Number	:	1972887115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD V TAYLOR SR.

Provider Business Mailing Address
First Line	:	729 NE 32ND ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73105-7530
Country	:	US
Telephone Number	:	405-962-9575
Fax Number	:	405-600-9953

Provider Business Practice Location Address
First Line	:	729 NE 32ND ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73105-7530
Country	:	US
Telephone Number	:	405-962-9575
Fax Number	:	405-600-9953

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

Provider Enumeration Date	:	10/06/2011
Last Update Date	:	10/06/2011

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Directions to “ EDWARD V TAYLOR SR. ” Practice Location

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