Provider Demographics
NPI:1184659773
Name:MERIDIAN HUMAN SERVICES
Entity Type:Organization
Organization Name:MERIDIAN HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGHEE
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW
Authorized Official - Phone:248-599-1763
Mailing Address - Street 1:PO BOX 74777
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-0777
Mailing Address - Country:US
Mailing Address - Phone:248-559-1763
Mailing Address - Fax:
Practice Address - Street 1:25820 SOUTHFIELD RD
Practice Address - Street 2:STE 107
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-1826
Practice Address - Country:US
Practice Address - Phone:248-559-1763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJM063867103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P09860Medicare ID - Type Unspecified