Healthcare Provider Details

I. General information

NPI: 1003709908
Provider Name (Legal Business Name): TAYLOR HEALING INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 05/30/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 CRESTMARK BLVD APT 1514
LITHIA SPRINGS GA
30122-4431
US

IV. Provider business mailing address

1440 W TAYLOR ST # 482
CHICAGO IL
60607-4623
US

V. Phone/Fax

Practice location:
  • Phone: 312-379-9790
  • Fax: 312-379-9790
Mailing address:
  • Phone: 312-379-9790
  • Fax: 312-379-9790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. STEPHANIE TAYLOR
Title or Position: LICENSED CLINICAL PROFESSIONAL COUN
Credential: LCPC
Phone: 312-379-9790