Provider Demographics
NPI:1154744167
Name:TAYLOR, STEPHANIE (MA, LLPC, NCC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MA, LLPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3652 BERNICE AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-1005
Mailing Address - Country:US
Mailing Address - Phone:586-872-0624
Mailing Address - Fax:
Practice Address - Street 1:1693 W HAMLIN RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3312
Practice Address - Country:US
Practice Address - Phone:248-299-2999
Practice Address - Fax:248-299-2994
Is Sole Proprietor?:No
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013583101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor