Healthcare Provider Details

I. General information

NPI: 1891331955
Provider Name (Legal Business Name): TAYLOR NOEL MCCONNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 STARRET ST STE 100
LANCASTER OH
43130-3993
US

IV. Provider business mailing address

106 STARRET ST STE 100
LANCASTER OH
43130-3993
US

V. Phone/Fax

Practice location:
  • Phone: 740-687-0042
  • Fax:
Mailing address:
  • Phone: 740-687-6677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2103489
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: