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General NPI Number Information
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NPI Number | 1376722264
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Entity Type | Organization
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Legal Business Name | MYRTLE C. MEANS, PH.D., P.C.
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Dates
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Enumeration Date | 10/29/2007
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Last Update Date | 09/11/2019
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Provider Practice Location Address
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Address Line | 23003 GREATER MACK AVE STE B
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-1965
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Country | US
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Telephone | 313-574-6616
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Fax |
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Provider Business Mailing Address
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Address Line | 11285 ELKINS RD STE D3
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City | ROSWELL
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State | GA
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Zip | 30076-5835
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Country | US
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Telephone | 313-574-6616
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | MYRTLE CHARISSE MEANS
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Credential | PHD
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Telephone | 313-574-6616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301011889
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License Number State | MI
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