Provider Demographics
NPI:1134625759
Name:SHELLEY A TAYLOR
Entity type:Organization
Organization Name:SHELLEY A TAYLOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LLP, LLC
Authorized Official - Phone:248-672-9275
Mailing Address - Street 1:26105 ORCHARD LAKE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-4577
Mailing Address - Country:US
Mailing Address - Phone:248-672-9275
Mailing Address - Fax:
Practice Address - Street 1:59031 MONTEGO DR STE 100
Practice Address - Street 2:
Practice Address - City:NEW HUDSON
Practice Address - State:MI
Practice Address - Zip Code:48165-9532
Practice Address - Country:US
Practice Address - Phone:248-672-9275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-03
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty