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NPI Code Detail

MEDICARE: TAYLOR EQ INSTITUTE LLC

MEDICARE: TAYLOR EQ INSTITUTE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1053981738
Entity Type Code : Organization
Provider Name (Legal Business Name) : TAYLOR EQ INSTITUTE LLC
Provider Business Mailing Address
First Line : 1824 W 107TH PL
Second Line :
City : CHICAGO
State : IL
Zip : 60643-3326
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1824 W 107TH PL
Second Line :
City : CHICAGO
State : IL
Zip : 60643-3326
Country : US
Telephone Number : 773-574-4636
Fax Number :
Authorized Official
Title or Position : OWNER
Name : IEISHA NORRIS
Credential : LCPC
Telephone Number : 773-574-4636
Provider Enumeration Date : 06/25/2021
Last Update Date : 06/25/2021

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Directions to “TAYLOR EQ INSTITUTE LLC ” Practice Location

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