Taylor Michelle Black, PHD
Individual provider Active NPI Clinical Psychologist · Conway, AR
NPI 1447922935 · NPPES record last updated Oct 29, 2022
Key facts
- NPI
- 1447922935
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 202118 (AR)
- Practice address
- 2220 Washington Ave
Conway, AR 72032-2762 - Phone
- (501) 679-0232
- NPI assigned
- Oct 2, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221112000058 | AR | Practitioner - Clinical Psychologist | 9436526969 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Heal Within Counseling and Consulting Inc | Current |
Accepting new patients |
Locations
2220 Washington Ave
Conway, AR 72032
Phone (501) 679-0232
575 Harkrider St
#A
Conway, AR 72032
Phone (501) 679-0232
8 S Broadview St
Ste E
Greenbrier, AR 72058
Phone (501) 679-0232
220 S Broadview St
Greenbrier, AR 72058
Phone (501) 679-0232
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 202118 | AR | Yes |
Addresses
Primary practice location
2220 Washington Ave
Conway, AR 72032-2762
Mailing address
540 Cherub Dr
Conway, AR 72034-3363
Other practice location 1
8 S Broadview St Ste Eandf
Greenbrier, AR 72058-9601
Phone (501) 679-0232
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | psychsolutionstblack@gmail.com | Direct |
Other providers in Conway, AR
- Kaleb Andrew Bivens
- Christi Bjornberg
- Harold Black
- Jessica Black
- Nickolas Black
- Kalone Blackmon
- Zachary Blackmon
- Arlinda Blackwell-El
- Wendy J Blackwood
- Cameria Blake
All providers in Conway, AR · Clinical Psychologist in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 29, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.