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General NPI Number Information
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NPI Number | 1780698449
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Entity Type | Individual
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Provider Name | JEREMIAH TAYLOR LPC NCC SAP CEAP
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Gender | Male
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3086 WOODLEY ROAD SUITE 3
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City | MONTGOMERY
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State | AL
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Zip | 36116-5404
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Country | US
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Telephone | 334-235-0995
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Fax |
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Provider Business Mailing Address
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Address Line | 3609 CARRIAGE PL
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City | MONTGOMERY
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State | AL
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Zip | 36116
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Country | US
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Telephone | 334-235-0995
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 768
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License Number State | AL
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