Provider Demographics
NPI:1164961199
Name:MAXEY, TAYLOR (LLPC)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:MAXEY
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44000 W 12 MILE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2646
Mailing Address - Country:US
Mailing Address - Phone:248-226-3001
Mailing Address - Fax:248-347-6479
Practice Address - Street 1:44000 W 12 MILE RD STE 101
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2646
Practice Address - Country:US
Practice Address - Phone:248-226-3001
Practice Address - Fax:248-347-6479
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401018955101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor