Provider Demographics
NPI:1578000485
Name:TAYLOR, ALESHA RENE'
Entity Type:Individual
Prefix:
First Name:ALESHA
Middle Name:RENE'
Last Name:TAYLOR
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 1:401 S WASHINGTON SQ UNIT 304
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48933-2148
Mailing Address - Country:US
Mailing Address - Phone:616-427-6816
Mailing Address - Fax:
Practice Address - Street 1:401 S WASHINGTON SQ UNIT 304
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48933-2148
Practice Address - Country:US
Practice Address - Phone:616-427-6816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician