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NPI Code Detail

MEDICARE: MAXWELL TAYLOR

MEDICARE: MAXWELL TAYLOR
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
1103T00000XPsychologist

General Provider Information

NPI Number : 1205490240
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAXWELL TAYLOR
Provider Business Mailing Address
First Line : 4310 LEONARD ST NW STE 103
Second Line :
City : WALKER
State : MI
Zip : 49534-8447
Country : US
Telephone Number : 616-453-6329
Fax Number :
Provider Business Practice Location Address
First Line : 401 HALL ST SW STE 112B
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-4988
Country : US
Telephone Number : 734-383-0932
Fax Number :
Authorized Official
Title or Position : PROVIDER
Name : MAXWELL TAYLOR
Credential : PSYD DLLP
Telephone Number : 734-383-0932
Provider Enumeration Date : 04/25/2019
Last Update Date : 04/25/2019

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Directions to “MAXWELL TAYLOR ” Practice Location

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