Healthcare Provider Details

I. General information

NPI: 1144764341
Provider Name (Legal Business Name): TAYLOR GRANTHAM LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2016
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22255 GREENFIELD RD STE 300
SOUTHFIELD MI
48075-3729
US

IV. Provider business mailing address

39715 JOHN DR
CANTON MI
48187-4209
US

V. Phone/Fax

Practice location:
  • Phone: 248-849-3301
  • Fax:
Mailing address:
  • Phone: 734-233-5384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401224450
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6451018854
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: