Healthcare Provider Details

I. General information

NPI: 1790690345
Provider Name (Legal Business Name): JEAN TAYLOR CIT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2804 FORUM BLVD STE 4
COLUMBIA MO
65203-6322
US

IV. Provider business mailing address

2804 FORUM BLVD STE 4
COLUMBIA MO
65203-6322
US

V. Phone/Fax

Practice location:
  • Phone: 573-586-3204
  • Fax: 573-646-0159
Mailing address:
  • Phone: 573-586-3204
  • Fax: 573-646-0159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: