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General NPI Number Information
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NPI Number | 1063856417
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Entity Type | Organization
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Legal Business Name | TAYLOR PSYCHOLOGICAL SERVICES PC
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Dates
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Enumeration Date | 04/28/2013
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Last Update Date | 05/15/2013
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Provider Practice Location Address
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Address Line | 1300 W BELMONT AVE SUITE 115
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City | CHICAGO
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State | IL
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Zip | 60657-3200
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Country | US
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Telephone | 312-753-9465
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Fax | 773-442-0056
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Provider Business Mailing Address
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Address Line | 1300 W BELMONT AVE SUITE 115
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City | CHICAGO
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State | IL
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Zip | 60657-3200
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Country | US
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Telephone | 312-753-9465
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Fax | 773-442-0056
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Authorized Official
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Title or Position | OWNER/LIC CLINICAL PSYCHOLOGIST
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Name | DR. KRISTEN A TAYLOR
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Credential | PSY.D.
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Telephone | 312-753-9465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.007840
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License Number State | IL
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