Healthcare Provider Details

I. General information

NPI: 1215955117
Provider Name (Legal Business Name): LYNN THERESE MEJIA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 E 12 MILE RD
WARREN MI
48093-3472
US

IV. Provider business mailing address

39012 LANSE CREUSE ST
HARRISON TOWNSHIP MI
48045-2065
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-5872
  • Fax: 586-573-5583
Mailing address:
  • Phone: 248-835-2124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801087224
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: