Provider Demographics
NPI:1407200678
Name:HESSELL, TAYLOR (LMSW)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:HESSELL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:TRYBAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:6549 TOWN CENTER DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-4824
Mailing Address - Country:US
Mailing Address - Phone:248-620-6400
Mailing Address - Fax:248-620-6405
Practice Address - Street 1:8150 OLD 13 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093
Practice Address - Country:US
Practice Address - Phone:586-825-9700
Practice Address - Fax:586-825-9701
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010986801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical