Healthcare Provider Details

I. General information

NPI: 1124006895
Provider Name (Legal Business Name): JACQUELINE ADELINE MEYERS PSY.D, LP, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2955 BIDDLE AVE STE 200
WYANDOTTE MI
48192-5231
US

IV. Provider business mailing address

3247 BIDDLE AVE APT 2
WYANDOTTE MI
48192-5951
US

V. Phone/Fax

Practice location:
  • Phone: 734-991-3234
  • Fax: 734-324-1566
Mailing address:
  • Phone: 734-991-3234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401008214
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301015288
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: