Healthcare Provider Details

I. General information

NPI: 1720752447
Provider Name (Legal Business Name): KENESHA TAYLOR LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 23 MILE RD STE 103
SHELBY TOWNSHIP MI
48315-2767
US

IV. Provider business mailing address

2250 BUTTERFIELD DR STE 150
TROY MI
48084-3478
US

V. Phone/Fax

Practice location:
  • Phone: 248-602-2593
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401225454
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: