Provider Information for 1811299779
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JESSE OWEN TAYLOR LCSW
Sex: Male
NPI: 1811299779
Last Updated: 2013-10-16
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1811299779 | ||||||||
| Enumeration Date | 2010-11-29 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2413 BAYSHORE BLVD UNIT # 1803 TAMPA, FL 33629-7351 United States Phone: 813-731-9552 | Fax: | ||||||||
| Primary Practice Address | 1536 NORTH JEFFERSON STREET VA JACKSONVILLE OPC MENTAL HEALTH JACKSONVILLE, FL 32209 United States Phone: 707-995-7201 | Fax: | ||||||||
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