=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598922528
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN CHRISTOPHER TAGGART JR. LPC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2008
-----------------------------------------------------
Last Update Date | 05/19/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2922 EAST CLEVELAND BLVD. SUITE 300
-----------------------------------------------------
City | CALDWELL
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-880-1341
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2922 EAST CLEVELAND BLVD. SUITE 300
-----------------------------------------------------
City | CALDWELL
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-880-1341
-----------------------------------------------------
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 | LPC-3795
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------