Provider Demographics
NPI:1528577004
Name:LEWIS, TAYLOR
Entity Type:Individual
Prefix:MISS
First Name:TAYLOR
Middle Name:
Last Name:LEWIS
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 1:31557 SCHOOLCRAFT RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-1848
Mailing Address - Country:US
Mailing Address - Phone:734-466-5021
Mailing Address - Fax:
Practice Address - Street 1:31557 SCHOOLCRAFT RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150
Practice Address - Country:US
Practice Address - Phone:734-466-5021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician