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General NPI Number Information
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NPI Number | 1861956815
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Entity Type | Individual
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Provider Name | GUY O TAYLOR SR.
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Gender | Male
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Dates
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Enumeration Date | 01/23/2019
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Last Update Date | 10/14/2021
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Provider Practice Location Address
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Address Line | 10343 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60643-2410
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Country | US
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Telephone | 916-470-1816
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Fax |
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Provider Business Mailing Address
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Address Line | 10343 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60643-2410
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Country | US
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Telephone | 916-470-1816
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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 | 167G00000X
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Taxonomy Name | Licensed Psychiatric Technician
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License Number | PT30264
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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