Healthcare Provider Details

I. General information

NPI: 1851238257
Provider Name (Legal Business Name): ALYSSA TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 WASHTENAW AVE
ANN ARBOR MI
48104-4532
US

IV. Provider business mailing address

23421 BAKER ST
TAYLOR MI
48180-7306
US

V. Phone/Fax

Practice location:
  • Phone: 313-241-4095
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6362009816
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: