Healthcare Provider Details

I. General information

NPI: 1063954626
Provider Name (Legal Business Name): TAYLOR HICKS-HOSTE PH.D, TLLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N MAIN ST STE. 220
CHELSEA MI
48118-1370
US

IV. Provider business mailing address

350 N MAIN ST STE. 220
CHELSEA MI
48118-1370
US

V. Phone/Fax

Practice location:
  • Phone: 734-433-5100
  • Fax:
Mailing address:
  • Phone: 734-433-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number6301016870
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberPP0000000891687
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: