Provider Demographics
NPI:1164792941
Name:MAXWELL TAYLOR PHD PC
Entity Type:Organization
Organization Name:MAXWELL TAYLOR PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXWELL
Authorized Official - Middle Name:F
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:II
Authorized Official - Credentials:PHD
Authorized Official - Phone:810-232-8466
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-0010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3405 WESTWOOD PKWY
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-4686
Practice Address - Country:US
Practice Address - Phone:810-232-8466
Practice Address - Fax:810-232-7413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B54526Medicare PIN