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NPI Code Detail

MEDICARE: MR. OWEN RUSSELL TAYLOR

MEDICARE: MR. OWEN RUSSELL TAYLOR
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
1101YA0400XAddiction (Substance Use Disorder) Counselor923209OH

General Provider Information

NPI Number : 1487182606
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. OWEN RUSSELL TAYLOR
Provider Business Mailing Address
First Line : PO BOX 10844
Second Line :
City : CLEVELAND
State : OH
Zip : 44110-0844
Country : US
Telephone Number : 216-391-0977
Fax Number : 216-391-0978
Provider Business Practice Location Address
First Line : 3030 EUCLID AVE STE 312
Second Line :
City : CLEVELAND
State : OH
Zip : 44115-2518
Country : US
Telephone Number : 216-391-0977
Fax Number : 216-391-0978
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2017
Last Update Date : 06/01/2017

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Directions to “ MR. OWEN RUSSELL TAYLOR ” Practice Location

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