Healthcare Provider Details

I. General information

NPI: 1922598531
Provider Name (Legal Business Name): KALA TAYLOR PHD, LP-HSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 08/12/2022
Certification Date: 10/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 KINGSTON PIKE STE 187
KNOXVILLE TN
37919-5026
US

IV. Provider business mailing address

5201 KINGSTON PIKE # 178
KNOXVILLE TN
37919-5026
US

V. Phone/Fax

Practice location:
  • Phone: 865-229-4746
  • Fax:
Mailing address:
  • Phone: 865-229-4746
  • Fax: 865-229-3242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number11466
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3655
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3655
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3655
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: