Provider Demographics
NPI:1780337758
Name:TAYLOR NEZICH LLC
Entity type:Organization
Organization Name:TAYLOR NEZICH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:NEZICH
Authorized Official - Suffix:
Authorized Official - Credentials:LLP
Authorized Official - Phone:734-415-6400
Mailing Address - Street 1:5340 PLYMOUTH RD STE 210
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9559
Mailing Address - Country:US
Mailing Address - Phone:734-415-6400
Mailing Address - Fax:
Practice Address - Street 1:5340 PLYMOUTH RD STE 210
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9559
Practice Address - Country:US
Practice Address - Phone:734-415-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty