Healthcare Provider Details

I. General information

NPI: 1326473216
Provider Name (Legal Business Name): MATTHEW JAMES TAYLOR MHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2789 ORTIZ AVE
FORT MYERS FL
33905-7806
US

IV. Provider business mailing address

13971 N CLEVELAND AVE STE 9
N FORT MYERS FL
33903-4392
US

V. Phone/Fax

Practice location:
  • Phone: 239-275-3222
  • Fax: 239-791-0111
Mailing address:
  • Phone: 239-997-7770
  • Fax: 239-997-7776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: