Provider Demographics
NPI:1154830503
Name:TAYLOR, LATOYA (PHD, LLP)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PHD, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27030 BELMONT LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-3115
Mailing Address - Country:US
Mailing Address - Phone:248-897-0795
Mailing Address - Fax:
Practice Address - Street 1:27030 BELMONT LN
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-3115
Practice Address - Country:US
Practice Address - Phone:248-897-0795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016761103TC0700X
MI6351004325103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical