Provider Demographics
NPI:1336494350
Name:MEINKE, MARY BETH (LLPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:MEINKE
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:BETH
Other - Last Name:WALCZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLPC
Mailing Address - Street 1:2387 E WALTON BLVD
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-1955
Mailing Address - Country:US
Mailing Address - Phone:248-620-6400
Mailing Address - Fax:248-620-6403
Practice Address - Street 1:2387 E WALTON BLVD
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-1955
Practice Address - Country:US
Practice Address - Phone:248-620-6400
Practice Address - Fax:248-620-6403
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013160101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional