Healthcare Provider Details

I. General information

NPI: 1568038065
Provider Name (Legal Business Name): TAYLOR KEYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 E CEDAR AVE
GLADWIN MI
48624-2215
US

IV. Provider business mailing address

2419 MORNING DAWN DR
MIDLAND MI
48642-5248
US

V. Phone/Fax

Practice location:
  • Phone: 989-426-9295
  • Fax:
Mailing address:
  • Phone: 989-225-7153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401019385
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: