Healthcare Provider Details

I. General information

NPI: 1295353886
Provider Name (Legal Business Name): TAYLOR MADE COUNSELING & WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 S FRONT ST
DARDANELLE AR
72834-4028
US

IV. Provider business mailing address

20 JOSH CIR
RUSSELLVILLE AR
72802-9431
US

V. Phone/Fax

Practice location:
  • Phone: 479-317-1398
  • Fax:
Mailing address:
  • Phone: 479-317-1398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. STEPHANIE P TAYLOR
Title or Position: CEO/OWNER
Credential: LCSW
Phone: 479-317-1398