Provider Demographics
NPI:1053522789
Name:TAYLOR, PENNY ANNETTE (LMHC)
Entity type:Individual
Prefix:MS
First Name:PENNY
Middle Name:ANNETTE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 953363
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32795-3363
Mailing Address - Country:US
Mailing Address - Phone:407-227-7599
Mailing Address - Fax:
Practice Address - Street 1:450 E HIGHWAY 50 # SUT6
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2581
Practice Address - Country:US
Practice Address - Phone:352-243-9733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4327101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health