Provider Demographics
NPI:1609934579
Name:TAYLOR, AMIE LOU (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMIE
Middle Name:LOU
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3456 PIERSON PL
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-2474
Mailing Address - Country:US
Mailing Address - Phone:810-720-5258
Mailing Address - Fax:
Practice Address - Street 1:3456 PIERSON PL
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-2474
Practice Address - Country:US
Practice Address - Phone:810-720-5258
Practice Address - Fax:810-720-5259
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002278103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680B545470OtherBLUE CROSS BLUE SHIELD
OM35440Medicare ID - Type Unspecified