Individual
MRS. TAKARA TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LLP
Contact information
Practice address
6505 CHERRY MEADOW DR SE, CALEDONIA, MI 49316-9484
(616) 891-8770
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6361008044
MI
103TC0700X
Clinical Psychologist
6362009539
MI
106S00000X
Behavior Technician
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
$$$$$$$$$
TECHNICIAN
MI
05
—
1356883003
—
MI
Enumeration date
11/11/2016
Last updated
08/21/2024
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