Provider Demographics
NPI:1902159759
Name:TAYLOR, SHELLEY ANN (MA, LLP)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:ANN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:ANN
Other - Last Name:STRIEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LLP
Mailing Address - Street 1:59031 MONTEGO DR
Mailing Address - Street 2:
Mailing Address - City:NEW HUDSON
Mailing Address - State:MI
Mailing Address - Zip Code:48165-9532
Mailing Address - Country:US
Mailing Address - Phone:248-672-9275
Mailing Address - Fax:
Practice Address - Street 1:59031 MONTEGO DR
Practice Address - Street 2:
Practice Address - City:NEW HUDSON
Practice Address - State:MI
Practice Address - Zip Code:48165-9532
Practice Address - Country:US
Practice Address - Phone:248-672-9275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007651103TC0700X
MI6361003484103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical