Basic Information
| Provider Information | |||||||||
| NPI: | 1598980195 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | JULIETTE | ||||||||
| MiddleName: | TONIA | ||||||||
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| Credential: | LPC, TLLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2065 BROOK TRAILS CT SE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495082654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162473975 | ||||||||
| FaxNumber: | 6164565800 | ||||||||
| Practice Location | |||||||||
| Address1: | 1101 BALL AVE NE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495055904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6164566571 | ||||||||
| FaxNumber: | 6164565800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LPC6401010104 | MI | X | Behavioral Health & Social Service Providers | Counselor | Professional | 103TC1900X | TLLP6301013292 | MI | X | Behavioral Health & Social Service Providers | Psychologist | Counseling | 106H00000X | MFC37620 | CA | X | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.