Healthcare Provider Details

I. General information

NPI: 1588584130
Provider Name (Legal Business Name): MR. ROY L TAYLOR JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28945 STATE ROAD 54 STE 102
WESLEY CHAPEL FL
33543-3218
US

IV. Provider business mailing address

306 W SADIE ST
BRANDON FL
33510-4440
US

V. Phone/Fax

Practice location:
  • Phone: 813-438-5949
  • Fax:
Mailing address:
  • Phone: 813-438-5949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH28147
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: