Provider Demographics
NPI:1619014735
Name:TAYLOR, DANIEL KENNETH (LMSW)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:KENNETH
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:08580 SUNSET MEADOW
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720
Mailing Address - Country:US
Mailing Address - Phone:231-547-9181
Mailing Address - Fax:
Practice Address - Street 1:ONE MACDONALD DRIVE SUITE B
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770
Practice Address - Country:US
Practice Address - Phone:213-347-6701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010725611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical