Provider Demographics
NPI:1619863107
Name:HARRIS, TAYLOR JASMINE-ALICIA (LLMSW)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:JASMINE-ALICIA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 MERRILL ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1852
Mailing Address - Country:US
Mailing Address - Phone:269-598-6113
Mailing Address - Fax:
Practice Address - Street 1:6963 W KL AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-8043
Practice Address - Country:US
Practice Address - Phone:269-459-9790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1041S0200X
MI6851119012104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool