=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164092375
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. OLUWATOSIN TOSIN M TAYLOR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2021
-----------------------------------------------------
Last Update Date | 06/29/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10104 SENATE DR STE 22220772
-----------------------------------------------------
City | LANHAM
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20706-4392
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-432-0286
-----------------------------------------------------
Fax | 240-523-9876
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16112 MCCONNELL DR # 20772
-----------------------------------------------------
City | UPPER MARLBORO
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20772-3283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-432-0286
-----------------------------------------------------
Fax | 240-523-9876
-----------------------------------------------------
=====================================================
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 |
-----------------------------------------------------
License Number State |
-----------------------------------------------------