Healthcare Provider Details

I. General information

NPI: 1386317675
Provider Name (Legal Business Name): TAYLOR MARIE STOCKSTILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2021
Last Update Date: 08/01/2021
Certification Date: 08/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6550 BIRCHBROOK LN APT 5
MEMPHIS TN
38134-7892
US

IV. Provider business mailing address

6550 BIRCHBROOK LN APT 5
MEMPHIS TN
38134-7892
US

V. Phone/Fax

Practice location:
  • Phone: 190-144-4243
  • Fax:
Mailing address:
  • Phone: 901-444-2433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: