Healthcare Provider Details

I. General information

NPI: 1700496197
Provider Name (Legal Business Name): LOOKING FOR A MIRACLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2020
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24166 TRAFALGAR CT
NOVI MI
48374-3667
US

IV. Provider business mailing address

24166 TRAFALGAR CT
NOVI MI
48374-3667
US

V. Phone/Fax

Practice location:
  • Phone: 248-497-1001
  • Fax:
Mailing address:
  • Phone: 248-497-1001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREA L TAYLOR
Title or Position: PRESIDENT/CEO
Credential: PSYD
Phone: 248-767-7647