Healthcare Provider Details

I. General information

NPI: 1689968257
Provider Name (Legal Business Name): AMELIA M. TAYLOR M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1246 ROEMER BLVD
FARRELL PA
16121-1734
US

IV. Provider business mailing address

303 E BUTLER ST
MERCER PA
16137-1116
US

V. Phone/Fax

Practice location:
  • Phone: 724-558-5063
  • Fax: 724-662-7208
Mailing address:
  • Phone: 724-558-5063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC007543
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: