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General NPI Number Information
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NPI Number | 1548606247
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Entity Type | Organization
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Legal Business Name | EDWARD C. TAYLOR, PHD. PL
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Dates
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Enumeration Date | 05/21/2013
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Last Update Date | 05/21/2013
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Provider Practice Location Address
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Address Line | 3750 SAN JOSE PL SUITE 35
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City | JACKSONVILLE
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State | FL
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Zip | 32257-8858
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Country | US
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Telephone | 904-886-9006
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Fax |
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Provider Business Mailing Address
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Address Line | 3750 SAN JOSE PL SUITE 35
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City | JACKSONVILLE
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State | FL
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Zip | 32257-8858
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Country | US
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Telephone | 904-886-9006
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. EDWARD C TAYLOR
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Credential | PHD
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Telephone | 904-886-9006
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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 | PY7903
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License Number State | FL
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