Provider Demographics
NPI:1407578990
Name:TALLEY, TAYLOR MONET
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MONET
Last Name:TALLEY
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 1:36320 UNION LAKE RD APT 302
Mailing Address - Street 2:
Mailing Address - City:HARRISON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48045-6627
Mailing Address - Country:US
Mailing Address - Phone:616-216-5976
Mailing Address - Fax:
Practice Address - Street 1:33646 SCHOENHERR RD
Practice Address - Street 2:SUITE 180
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312
Practice Address - Country:US
Practice Address - Phone:586-999-5971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI890935608OtherBLUE CROSS BLUE SHIELD