Individual provider Active NPI

Takara Taylor, LLP

  • Psychologist
  • Caledonia, MI
National Provider Identifier
1356883003
Registry record updated Aug 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
6361008044 Issued in MI
Practice address
6505 Cherry Meadow Dr SE
Caledonia, MI 49316-9484
Phone
(616) 891-8770
NPI assigned
Nov 11, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 6362009539 MI
Behavior Technician 106S00000X MI
Psychologist 103T00000X 6361008044 MI Primary

Addresses

Primary practice location

6505 Cherry Meadow Dr SE
Caledonia, MI 49316-9484

Mailing address

300 68TH St SE
Grand Rapids, MI 49548-6927
Phone (616) 455-5000

Other practice location 1

300 68th St SE
Grand Rapids, MI 49548-6927
Phone (616) 455-5000

Other practice location 2

3300 36th St SE
Grand Rapids, MI 49512-2810
Phone (616) 589-2053

Other practice location 3

1260 Ekhart St NE
Grand Rapids, MI 49503
Phone (616) 589-2053

Other identifiers 2

IdentifierTypeStateIssuer
1356883003MedicaidMI
$$$$$$$$$OtherMITECHNICIAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
6361008044MIMDPsychologist
6362009539MIMDClinical Psychologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1478822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724198400000",
    "number": "1356883003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495486927",
            "telephone_number": "616-455-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6505 CHERRY MEADOW DR SE",
            "city": "CALEDONIA",
            "state": "MI",
            "postal_code": "493169484",
            "telephone_number": "616-891-8770"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 68th St SE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495486927",
            "country_code": "US",
            "telephone_number": "616-455-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3300 36th St SE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495122810",
            "country_code": "US",
            "telephone_number": "616-589-2053",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1260 Ekhart St NE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "49503",
            "country_code": "US",
            "telephone_number": "616-589-2053",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAYLOR",
        "first_name": "TAKARA",
        "name_prefix": "Mrs.",
        "credential": "LLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-11",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6362009539",
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6361008044",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1356883003",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TECHNICIAN",
            "identifier": "$$$$$$$$$",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Caledonia, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.