Healthcare Provider Details

I. General information

NPI: 1952811812
Provider Name (Legal Business Name): JORDYN TAYLOR MILLER LCSW, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JORDYN TAYLOR MCCARTHY

II. Dates (important events)

Enumeration Date: 10/05/2017
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44725 GRAND RIVER AVE STE 104
NOVI MI
48375-1024
US

IV. Provider business mailing address

44725 GRAND RIVER AVE STE 104
NOVI MI
48375-1024
US

V. Phone/Fax

Practice location:
  • Phone: 248-846-8345
  • Fax:
Mailing address:
  • Phone: 248-846-8345
  • Fax: 734-243-5506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801109346
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149023397
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: