Healthcare Provider Details

I. General information

NPI: 1760347074
Provider Name (Legal Business Name): TAYLOR SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 W HERNANDEZ ST
PENSACOLA FL
32501-1938
US

IV. Provider business mailing address

730 W HERNANDEZ ST
PENSACOLA FL
32501-1938
US

V. Phone/Fax

Practice location:
  • Phone: 636-627-7788
  • Fax:
Mailing address:
  • Phone: 636-627-7788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2019015950
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: