MEDICARE: D. TAYLOR ENTERPRISE LLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1295179224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D. TAYLOR ENTERPRISE LLC

Provider Business Mailing Address
First Line	:	3009 STONE ARBOR LN
Second Line	:	APT 638
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-7584
Country	:	US
Telephone Number	:	804-551-4158
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 S FIGUEROA ST
Second Line	:	SUITE 4050
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-5704
Country	:	US
Telephone Number	:	804-551-4158
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DAWAYNE E TAYLOR
Credential	:	B.S.
Telephone Number	:	804-551-4158

Provider Enumeration Date	:	04/21/2013
Last Update Date	:	04/21/2013

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