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NPI Code Detail

MEDICARE: SOPHIA TAYLOR

MEDICARE: SOPHIA TAYLOR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior AnalystMI
2106E00000XAssistant Behavior Analyst

General Provider Information

NPI Number : 1104399534
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOPHIA TAYLOR
Provider Business Mailing Address
First Line : 625 FAIR OAKS AVE STE 200
Second Line :
City : SOUTH PASADENA
State : CA
Zip : 91030-2694
Country : US
Telephone Number : 323-341-5580
Fax Number : 323-340-8298
Provider Business Practice Location Address
First Line : 1742 CROOKS RD
Second Line :
City : TROY
State : MI
Zip : 48084-5501
Country : US
Telephone Number : 248-544-0360
Fax Number : 248-544-0388
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2019
Last Update Date : 07/22/2022

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Directions to “ SOPHIA TAYLOR ” Practice Location

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