Healthcare Provider Details

I. General information

NPI: 1184659773
Provider Name (Legal Business Name): MERIDIAN HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25820 SOUTHFIELD RD STE 107
SOUTHFIELD MI
48075-1826
US

IV. Provider business mailing address

PO BOX 74777
ROMULUS MI
48174-0777
US

V. Phone/Fax

Practice location:
  • Phone: 248-559-1763
  • Fax:
Mailing address:
  • Phone: 248-559-1763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberJM063867
License Number StateMI

VIII. Authorized Official

Name: MS. JOANN MCGHEE
Title or Position: CEO
Credential: ACSW
Phone: 248-599-1763