Healthcare Provider Details

I. General information

NPI: 1275860462
Provider Name (Legal Business Name): CHERYL ELLEN TAYLOR MA EDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 SOUTHVIEW DRIVE
BLUEFIELD WV
24701-4317
US

IV. Provider business mailing address

118 12TH STREET
PRINCETON WV
24740-2352
US

V. Phone/Fax

Practice location:
  • Phone: 304-325-4673
  • Fax: 304-327-9210
Mailing address:
  • Phone: 304-487-7936
  • Fax: 304-487-7835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number0
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number997
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number997
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number997
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number997
License Number StateWV
# 6
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number997
License Number State
# 7
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number997
License Number State
# 8
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number997
License Number State
# 9
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number997
License Number StateWV
# 10
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number997
License Number StateWV
# 11
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number997
License Number StateWV
# 12
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number997
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: