Provider Demographics
NPI:1053441915
Name:TAYLOR, MIRIAM ANNETTE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:ANNETTE
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 1:1193 CABOT DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-2635
Mailing Address - Country:US
Mailing Address - Phone:810-760-2675
Mailing Address - Fax:810-760-2094
Practice Address - Street 1:4925 PACKARD ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1521
Practice Address - Country:US
Practice Address - Phone:734-971-9781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801087536101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health