Healthcare Provider Details

I. General information

NPI: 1932170503
Provider Name (Legal Business Name): AMY JOANN TAYLOR LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7985 MACKINAW TRL
CADILLAC MI
49601-8111
US

IV. Provider business mailing address

3782 MOMENTUM PL
CHICAGO IL
60689-5337
US

V. Phone/Fax

Practice location:
  • Phone: 231-876-6200
  • Fax: 231-876-6299
Mailing address:
  • Phone: 231-876-7234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6801077319
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801077319
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: