Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 6401019803 | MI |
N | 103TC1900X | Counseling Psychologist | 6301017785 | MI |
N | 106S00000X | Behavior Technician |
NPI | 1003397266 |
---|---|
Provider Name | Brianna Taylor |
First Address | Hudsonville, MI 49426-8464 |
Second Address | Grand Rapids, MI 49546 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2018 |
Last Update Date | 06/10/2021 |