Provider Demographics
NPI:1114190840
Name:TAYLOR, JUNE EDNA (LLP)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:EDNA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24641 RENSSELAER ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1717
Mailing Address - Country:US
Mailing Address - Phone:248-495-0199
Mailing Address - Fax:
Practice Address - Street 1:25507 ECORSE RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-1555
Practice Address - Country:US
Practice Address - Phone:313-292-7640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010278103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist