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General NPI Number Information
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NPI Number | 1184266900
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Entity Type | Individual
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Provider Name | MISTY R TAYLOR MA, L.P.C.
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Gender | Female
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Dates
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Enumeration Date | 10/14/2019
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 6421 CAMP BOWIE BLVD STE 403
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City | FORT WORTH
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State | TX
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Zip | 76116-5422
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Country | US
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Telephone | 817-935-8468
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Fax |
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Provider Business Mailing Address
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Address Line | 401 FOCH ST APT 1229
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City | FORT WORTH
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State | TX
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Zip | 76107-2574
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Country | US
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Telephone | 325-370-0798
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 65539
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License Number State | TX
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