Provider Demographics
NPI:1285696385
Name:TAYLOR, CORA SUE (PSYS, LMHC)
Entity type:Individual
Prefix:MS
First Name:CORA
Middle Name:SUE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PSYS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 VIA ESPLANADE
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-6440
Mailing Address - Country:US
Mailing Address - Phone:941-637-7111
Mailing Address - Fax:941-637-7343
Practice Address - Street 1:315 E OLYMPIA AVE
Practice Address - Street 2:SUITE 252
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3831
Practice Address - Country:US
Practice Address - Phone:941-637-7111
Practice Address - Fax:941-637-7343
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4605101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL677796196Medicaid
FL677796196Medicaid