Healthcare Provider Details

I. General information

NPI: 1225150139
Provider Name (Legal Business Name): MERIDIAN PROFESSIONAL PSYCHOLOGICAL CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5031 PARK LAKE ROAD
EAST LANSING MI
48823-3835
US

IV. Provider business mailing address

5031 PARK LAKE ROAD
EAST LANSING MI
48823-3835
US

V. Phone/Fax

Practice location:
  • Phone: 517-332-0811
  • Fax: 517-332-4452
Mailing address:
  • Phone: 517-332-0811
  • Fax: 517-332-4452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number330070
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: MRS. BARBARA ANN GUNNINGS
Title or Position: DIRECTOR OF OPERATIONS
Credential: PHD LAC
Phone: 517-332-0811