Healthcare Provider Details

I. General information

NPI: 1932035045
Provider Name (Legal Business Name): MEREDITH REESE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 IVANHOE DR
WEST BLOOMFIELD MI
48324-1738
US

IV. Provider business mailing address

2440 IVANHOE DR
WEST BLOOMFIELD MI
48324-1738
US

V. Phone/Fax

Practice location:
  • Phone: 248-736-9084
  • Fax: 248-736-9084
Mailing address:
  • Phone: 248-736-9084
  • Fax: 248-736-9084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401008805
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: