Provider Demographics
NPI:1164631727
Name:TAYLOR, CHONTAY (PHD, RN, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:CHONTAY
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PHD, RN, PMHNP-BC
Other - Prefix:DR
Other - First Name:CHONTAY
Other - Middle Name:
Other - Last Name:TAYLOR GLENN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2089 ANITA AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1427
Mailing Address - Country:US
Mailing Address - Phone:313-459-6707
Mailing Address - Fax:313-731-0360
Practice Address - Street 1:2089 ANITA AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-1427
Practice Address - Country:US
Practice Address - Phone:313-459-6707
Practice Address - Fax:313-731-0360
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MI4704208682163WC1500X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health