Provider Demographics
NPI:1386923126
Name:TAYLOR, TRACY BELL
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:BELL
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 MALABAR RD SE STE 111-112
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-3239
Mailing Address - Country:US
Mailing Address - Phone:772-469-6466
Mailing Address - Fax:888-419-1172
Practice Address - Street 1:1150 MALABAR RD SE STE 111-112
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-3239
Practice Address - Country:US
Practice Address - Phone:772-469-6466
Practice Address - Fax:888-419-1172
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15656101YM0800X
FLSW179001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health