Healthcare Provider Details

I. General information

NPI: 1225697667
Provider Name (Legal Business Name): TAYLOR BURGESS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7547 MENTOR AVE STE 300
MENTOR OH
44060-5432
US

IV. Provider business mailing address

7547 MENTOR AVE STE 306
MENTOR OH
44060-5432
US

V. Phone/Fax

Practice location:
  • Phone: 440-701-6170
  • Fax: 440-527-8043
Mailing address:
  • Phone: 440-701-6170
  • Fax: 440-527-8043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2002829
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: