Provider Demographics
NPI:1265006035
Name:WEBSTER, TAYLOR ALEXIS
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ALEXIS
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 TIMBERVIEW DR APT 106
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4121
Mailing Address - Country:US
Mailing Address - Phone:586-850-7173
Mailing Address - Fax:
Practice Address - Street 1:10 TIMBERVIEW DR APT 106
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4121
Practice Address - Country:US
Practice Address - Phone:586-850-7173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical