Provider Demographics
NPI:1598345217
Name:WELLS, TAYLOR (MA, LLPC, NCC)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:MA, LLPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N. WEST AVE.
Mailing Address - Street 2:SUITE #300
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202
Mailing Address - Country:US
Mailing Address - Phone:517-789-1234
Mailing Address - Fax:517-784-7040
Practice Address - Street 1:1200 N. WEST AVE
Practice Address - Street 2:SUITE #300
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202
Practice Address - Country:US
Practice Address - Phone:517-789-1234
Practice Address - Fax:517-784-7040
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451019424101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor