MEDICARE: TAYLOR MARY HOWELL LLMSW

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
1	1041C0700X	Clinical Social Worker	6851119108	MI

General Provider Information

NPI Number	:	1629894076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR MARY HOWELL LLMSW

Provider Business Mailing Address
First Line	:	1216 OLD GUN CLUB CT SE
Second Line	:
City	:	LOWELL
State	:	MI
Zip	:	49331-9264
Country	:	US
Telephone Number	:	616-255-3899
Fax Number	:

Provider Business Practice Location Address
First Line	:	4764 FULTON ST E STE 204
Second Line	:
City	:	ADA
State	:	MI
Zip	:	49301-9086
Country	:	US
Telephone Number	:	616-200-4433
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2024
Last Update Date	:	12/02/2024

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