=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003918772
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GREGG WILLIAM TAYLOR III LMHC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7208 MASSACHUSETTS AVE
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34653-2934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-432-0748
-----------------------------------------------------
Fax | 727-339-3310
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 722 DERBY DR
-----------------------------------------------------
City | TARPON SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34689-8025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-432-0748
-----------------------------------------------------
Fax | 727-339-3310
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH5912
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | MH5912
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | MH5912
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------