Healthcare Provider Details

I. General information

NPI: 1619640844
Provider Name (Legal Business Name): LEAH SIMONE TAYLOR LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2021
Last Update Date: 07/25/2021
Certification Date: 07/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12025 MAGAZINE ST APT 7306
ORLANDO FL
32828-5515
US

IV. Provider business mailing address

10129 CLEAR VISTA ST
ORLANDO FL
32832-7164
US

V. Phone/Fax

Practice location:
  • Phone: 347-463-7304
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH19041
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: