=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366211385
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES TAYLOR GROVES
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2024
-----------------------------------------------------
Last Update Date | 01/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6708 TAYLOR CIR
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36117-3411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 36-933-4356
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 605 BELSER CT
-----------------------------------------------------
City | PIKE ROAD
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36064-2778
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-451-2602
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | ALC04129
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------