Healthcare Provider Details

I. General information

NPI: 1134818420
Provider Name (Legal Business Name): TAILORED CLINICAL SERVICES P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27030 BELMONT LN
SOUTHFIELD MI
48076-3115
US

IV. Provider business mailing address

27030 BELMONT LN
SOUTHFIELD MI
48076-3115
US

V. Phone/Fax

Practice location:
  • Phone: 248-897-0795
  • Fax:
Mailing address:
  • Phone: 248-897-0795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. LATOYA TAYLOR
Title or Position: OWNER
Credential: PHD
Phone: 248-897-0795