=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568353712
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STRIDE PSYCHOLOGY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2025
-----------------------------------------------------
Last Update Date | 07/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2222 W GRAND RIVER AVE STE A
-----------------------------------------------------
City | OKEMOS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48864-1604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-758-6603
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2222 W GRAND RIVER AVE STE A
-----------------------------------------------------
City | OKEMOS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48864-1604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-758-6603
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | MEGAN E MANIERSKI
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 586-808-1958
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------