Provider Demographics
NPI:1467627042
Name:SUZANNE S. TAYLOR MSW CSW ACSW LLC
Entity Type:Organization
Organization Name:SUZANNE S. TAYLOR MSW CSW ACSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MSW CSW ACSW LLC
Authorized Official - Phone:810-695-9466
Mailing Address - Street 1:9460 S SAGINAW RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8207
Mailing Address - Country:US
Mailing Address - Phone:810-695-9466
Mailing Address - Fax:810-695-4311
Practice Address - Street 1:9460 S SAGINAW RD
Practice Address - Street 2:SUITE D
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8207
Practice Address - Country:US
Practice Address - Phone:810-695-9466
Practice Address - Fax:810-695-4311
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUZANNE S. TAYLOR MSW CSW ACSW LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-24
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801065486251S00000X
MI101YM0800X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health