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General NPI Number Information
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NPI Number | 1598980195
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Entity Type | Individual
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Provider Name | JULIETTE TONIA TAYLOR LPC, TLLP
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Gender | Female
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1101 BALL AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-5904
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Country | US
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Telephone | 616-456-6571
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Fax | 616-456-5800
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Provider Business Mailing Address
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Address Line | 2065 BROOK TRAILS CT SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49508-2654
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Country | US
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Telephone | 616-247-3975
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Fax | 616-456-5800
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC6401010104
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | TLLP6301013292
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC37620
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License Number State | CA
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