Provider Demographics
NPI:1043586191
Name:TAYLOR, MICHELLE LATRECE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:LATRECE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5411 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-5928
Mailing Address - Country:US
Mailing Address - Phone:713-334-4134
Mailing Address - Fax:713-520-0552
Practice Address - Street 1:5411 JACKSON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-5928
Practice Address - Country:US
Practice Address - Phone:713-334-4134
Practice Address - Fax:713-520-0552
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52428104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker