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General NPI Number Information
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NPI Number | 1366628331
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Entity Type | Organization
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Legal Business Name | PHILIP R. TAFT PSY.D. PLLC
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Dates
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Enumeration Date | 01/21/2008
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Last Update Date | 07/06/2024
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Provider Practice Location Address
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Address Line | 715 W 2ND AVE
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City | CORSICANA
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State | TX
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Zip | 75110-3012
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Country | US
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Telephone | 903-872-4442
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Fax | 903-642-2550
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Provider Business Mailing Address
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Address Line | 1106 OAKLAWN DR
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City | CORSICANA
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State | TX
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Zip | 75110-2848
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Country | US
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Telephone | 903-872-4442
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST &MANAGER
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Name | DR. PHILIP RAYMOND TAFT
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Credential | PSY.D.
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Telephone | 903-872-4442
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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