Provider Demographics
NPI:1609565266
Name:TAYLOR, AMANDA (MS, LLP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3249 BROAD ST # 1
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130-1018
Mailing Address - Country:US
Mailing Address - Phone:734-274-9150
Mailing Address - Fax:
Practice Address - Street 1:3249 BROAD ST STE 1
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-1018
Practice Address - Country:US
Practice Address - Phone:734-834-5409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361001878103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist