Provider Demographics
NPI:1972151389
Name:TAYLOR-GOL, SUSAN
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:TAYLOR-GOL
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 1:8123 COVE TIMBERS LN
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-2675
Mailing Address - Country:US
Mailing Address - Phone:571-225-0215
Mailing Address - Fax:
Practice Address - Street 1:25510 TOMBALL PKWY
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-7730
Practice Address - Country:US
Practice Address - Phone:713-306-7061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77745101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health