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General NPI Number Information
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NPI Number | 1407571623
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Entity Type | Individual
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Provider Name | SAMANTHA SUSAN TAYLOR
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Gender | Female
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Dates
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Enumeration Date | 10/10/2022
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Last Update Date | 10/10/2022
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Provider Practice Location Address
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Address Line | 17 S DE VILLIERS ST
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City | PENSACOLA
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State | FL
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Zip | 32502-5511
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Country | US
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Telephone | 201-790-3022
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Fax |
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Provider Business Mailing Address
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Address Line | 1922 MOORING DR
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City | NAVARRE
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State | FL
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Zip | 32566-2164
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Country | US
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Telephone | 201-790-3022
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | FL
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