Healthcare Provider Details

I. General information

NPI: 1497890511
Provider Name (Legal Business Name): GAIL L. TAYLOR L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 SUPPIGER LN
HIGHLAND IL
62249-1132
US

IV. Provider business mailing address

17 FINLAY FLDS
MANCHESTER MO
63021-6757
US

V. Phone/Fax

Practice location:
  • Phone: 618-654-5990
  • Fax: 636-391-6773
Mailing address:
  • Phone: 636-391-6773
  • Fax: 636-391-6773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2003032158
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: