Provider Demographics
NPI:1780408021
Name:TAYLOR, TIYE (LLMSW)
Entity type:Individual
Prefix:
First Name:TIYE
Middle Name:
Last Name:TAYLOR
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 1:50 INDUSTRIAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:MI
Mailing Address - Zip Code:49013-1246
Mailing Address - Country:US
Mailing Address - Phone:269-427-7937
Mailing Address - Fax:269-427-5180
Practice Address - Street 1:5498 109TH AVE
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:MI
Practice Address - Zip Code:49450-9631
Practice Address - Country:US
Practice Address - Phone:855-869-6900
Practice Address - Fax:269-427-5180
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511111031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical