| Philip R. Taft Psy.d. Pllc | |
|
715 W 2nd Ave Corsicana TX 75110-3012 | |
| (903) 872-4442 | |
| (903) 642-2550 |
| Full Name | Philip R. Taft Psy.d. Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 715 W 2nd Ave, Corsicana, Texas |
| Authorized Official Name and Position | Philip Raymond Taft (CLINICAL PSYCHOLOGIST &MANAGER) |
| Authorized Official Contact | 9038724442 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Philip R. Taft Psy.d. Pllc 1106 Oaklawn Dr Corsicana TX 75110-2848 Ph: (903) 872-4442 | Philip R. Taft Psy.d. Pllc 715 W 2nd Ave Corsicana TX 75110-3012 Ph: (903) 872-4442 |
| NPI Number | 1366628331 |
|---|---|
| Provider Enumeration Date | 01/21/2008 |
| Last Update Date | 04/26/2024 |
| Certification Date | 12/12/2023 |
| Medicare PECOS PAC ID | 6204891138 |
|---|---|
| Medicare Enrollment ID | O20041119000754 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366628331 | NPI | - | NPPES |
| 0073MG | Other | TX | BLUE CROSS BLUE SHIELD TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 31452 (Texas) | Primary |
| Provider Name | Philip R Taft |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1285762120 PECOS PAC ID: 3375508203 Enrollment ID: I20041122000086 |
| Provider Name | Jenny Beatriz Henson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1023769411 PECOS PAC ID: 0749630937 Enrollment ID: I20231229003016 |
| Provider Name | Ana Maria Matei |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1558979401 PECOS PAC ID: 7618327701 Enrollment ID: I20240102003384 |
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