1790176220 NPI number — JUST IN TIME MENTAL HEALTH SERVICES

Table of content: DR. CHAD THOMAS TAYLOR PSY.D. (NPI 1336207760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790176220 NPI number — JUST IN TIME MENTAL HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JUST IN TIME MENTAL HEALTH SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790176220
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 37033
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH CHESTERFIELD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23234-7033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-405-7175
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 N 6TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOPEWELL
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23860-2618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-405-7175
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
804-255-0925

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  93001001 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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