Healthcare Provider Details

I. General information

NPI: 1073444659
Provider Name (Legal Business Name): KALEB TAYLOR MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N WYMORE RD
WINTER PARK FL
32789-2822
US

IV. Provider business mailing address

315 N WYMORE RD
WINTER PARK FL
32789-2822
US

V. Phone/Fax

Practice location:
  • Phone: 321-430-5966
  • Fax:
Mailing address:
  • Phone: 321-430-5966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH27874
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: