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General NPI Number Information
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NPI Number | 1477826477
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Entity Type | Individual
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Provider Name | TAYLOR LEE THOMPSON PH.D
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Gender | Female
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Dates
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Enumeration Date | 02/22/2012
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Last Update Date | 06/28/2017
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Provider Practice Location Address
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Address Line | 6867 SOUTHPOINT DR N
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City | JACKSONVILLE
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State | FL
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Zip | 32216-8043
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Country | US
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Telephone | 904-619-6071
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Fax |
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Provider Business Mailing Address
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Address Line | 6867 SOUTHPOINT DRIVE NORTH
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City | JACKSONVILLE
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State | FL
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Zip | 32216-5433
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Country | US
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Telephone | 904-619-6071
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY9883
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License Number State | FL
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