Healthcare Provider Details

I. General information

NPI: 1598980195
Provider Name (Legal Business Name): JULIETTE TONIA TAYLOR LPC, TLLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 BALL AVE NE
GRAND RAPIDS MI
49505-5904
US

IV. Provider business mailing address

2065 BROOK TRAILS CT SE
GRAND RAPIDS MI
49508-2654
US

V. Phone/Fax

Practice location:
  • Phone: 616-456-6571
  • Fax: 616-456-5800
Mailing address:
  • Phone: 616-247-3975
  • Fax: 616-456-5800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC6401010104
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberTLLP6301013292
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC37620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: