Provider Demographics
NPI:1255563805
Name:TAYLOR, BRIAN (LMSW)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4526 PERRY RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1626
Mailing Address - Country:US
Mailing Address - Phone:248-365-0450
Mailing Address - Fax:248-707-6481
Practice Address - Street 1:7460 M E CAD BLVD STE 1
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-4270
Practice Address - Country:US
Practice Address - Phone:248-365-0450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010910711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical