MEDICARE: DAVID LAMONT TAYLOR LMHC

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	MH 10553	FL
2	101YM0800X	Mental Health Counselor	39002156A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MH 10553	OTHER	FL	MENTAL HEALTH COUNSELOR

General Provider Information

NPI Number	:	1356631410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID LAMONT TAYLOR LMHC

Provider Business Mailing Address
First Line	:	5064 PARK CENTRAL DR
Second Line	:	1717
City	:	ORLANDO
State	:	FL
Zip	:	32839-5371
Country	:	US
Telephone Number	:	765-215-4825
Fax Number	:

Provider Business Practice Location Address
First Line	:	773 S KIRKMAN RD
Second Line	:	112
City	:	ORLANDO
State	:	FL
Zip	:	32811-2013
Country	:	US
Telephone Number	:	765-215-4825
Fax Number	:

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

Provider Enumeration Date	:	04/11/2011
Last Update Date	:	04/11/2011

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