Healthcare Provider Details

I. General information

NPI: 1649803925
Provider Name (Legal Business Name): JESSIE LEIGH TAYLOR LICDC, MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2020
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6202 TRUST DR
HOLLAND OH
43528-8425
US

IV. Provider business mailing address

550 WINTHROP ST
TOLEDO OH
43620-1116
US

V. Phone/Fax

Practice location:
  • Phone: 406-214-7532
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberM.2500350
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162055
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: