Healthcare Provider Details

I. General information

NPI: 1265255541
Provider Name (Legal Business Name): SAMUEL TAYLOR LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 EMERYVILLE DR STE 230
CRANBERRY TWP PA
16066-5020
US

IV. Provider business mailing address

125 EMERYVILLE DR STE 230
CRANBERRY TOWNSHIP PA
16066-5020
US

V. Phone/Fax

Practice location:
  • Phone: 724-609-5002
  • Fax:
Mailing address:
  • Phone: 724-609-5002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC021134
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: