Healthcare Provider Details

I. General information

NPI: 1003397266
Provider Name (Legal Business Name): BRIANNA TAYLOR LPC, TLLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2018
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

854 WASHINGTON AVE STE 600
HOLLAND MI
49423-7141
US

IV. Provider business mailing address

3727 KAYLEE LN
HUDSONVILLE MI
49426-8464
US

V. Phone/Fax

Practice location:
  • Phone: 616-499-2218
  • Fax:
Mailing address:
  • Phone: 269-547-2131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401019803
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301017785
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: