Provider Demographics
NPI:1891088639
Name:TAYLOR, MICHELLE MARIE (MS MHC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MARIE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-4701
Mailing Address - Country:US
Mailing Address - Phone:319-236-7290
Mailing Address - Fax:319-235-4364
Practice Address - Street 1:215 E 4TH ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-4701
Practice Address - Country:US
Practice Address - Phone:319-236-7290
Practice Address - Fax:319-235-4364
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health