MEDICARE: DR. TARYL A HOLBROOK PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	4155	FL

General Provider Information

NPI Number	:	1245449222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TARYL A HOLBROOK PH.D.

Provider Business Mailing Address
First Line	:	29200 BAY HOLLOW DR
Second Line	:	UNIT 3285
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543-4364
Country	:	US
Telephone Number	:	813-973-8022
Fax Number	:	813-991-6160

Provider Business Practice Location Address
First Line	:	29200 BAY HOLLOW DR
Second Line	:	UNIT 3285
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543-4364
Country	:	US
Telephone Number	:	813-973-8022
Fax Number	:	813-991-6160

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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