Healthcare Provider Details

I. General information

NPI: 1679496723
Provider Name (Legal Business Name): TAYLOR LEE MUNCY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 KEE CT
MADISON MS
39110-9794
US

IV. Provider business mailing address

313 KEE CT
MADISON MS
39110-9794
US

V. Phone/Fax

Practice location:
  • Phone: 304-633-3730
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810009468
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: