Healthcare Provider Details

I. General information

NPI: 1811623648
Provider Name (Legal Business Name): MALIQUE SAQUAN TAYLOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10865 GRANDVIEW DR STE 2065
OVERLAND PARK KS
66210-1519
US

IV. Provider business mailing address

10865 GRANDVIEW DR STE 2065
OVERLAND PARK KS
66210-1519
US

V. Phone/Fax

Practice location:
  • Phone: 913-390-3711
  • Fax:
Mailing address:
  • Phone: 760-847-4946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number04118
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: