Healthcare Provider Details

I. General information

NPI: 1245422542
Provider Name (Legal Business Name): RANDI I. TAYLOR PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 LINDSLEY AVE
NASHVILLE TN
37210-2038
US

IV. Provider business mailing address

314 CHESTERFIELD AVE
NASHVILLE TN
37212-4021
US

V. Phone/Fax

Practice location:
  • Phone: 615-259-9055
  • Fax: 615-259-9056
Mailing address:
  • Phone: 615-584-7559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP0000002692
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberP0000002692
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: