Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 6401003958 | MI |
N | 1041C0700X | Clinical Social Worker | 6801018821 | MI |
NPI | 1144688235 |
---|---|
Provider Name | David Ray Taylor |
First Address | Lambertville, MI 48144-8623 |
Second Address | Lambertville, MI 48144-8623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2016 |
Last Update Date | 03/02/2016 |