Provider Demographics
NPI:1366628331
Name:PHILIP R. TAFT PSY.D. PLLC
Entity type:Organization
Organization Name:PHILIP R. TAFT PSY.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST &MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:TAFT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:903-872-4442
Mailing Address - Street 1:1106 OAKLAWN DR
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-2848
Mailing Address - Country:US
Mailing Address - Phone:903-872-4442
Mailing Address - Fax:
Practice Address - Street 1:715 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-3012
Practice Address - Country:US
Practice Address - Phone:903-872-4442
Practice Address - Fax:903-642-2550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0073MGOtherBLUE CROSS BLUE SHIELD TX
TX0073MGOtherBLUE CROSS BLUE SHIELD TX