Provider Demographics
NPI:1003397266
Name:TAYLOR, BRIANNA (LPC, TLLP)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPC, TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3727 KAYLEE LN
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-8464
Mailing Address - Country:US
Mailing Address - Phone:269-547-2131
Mailing Address - Fax:
Practice Address - Street 1:854 WASHINGTON AVE STE 600
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-7141
Practice Address - Country:US
Practice Address - Phone:616-499-2218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301017785103TC1900X
106S00000X
MI6401019803101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician