Provider Demographics
NPI:1417665522
Name:MEININGER, JUDITH LYNN (TLLP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:LYNN
Last Name:MEININGER
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5066 CHAIN BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-3727
Mailing Address - Country:US
Mailing Address - Phone:248-766-1478
Mailing Address - Fax:
Practice Address - Street 1:675 E BIG BEAVER RD STE 207
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1428
Practice Address - Country:US
Practice Address - Phone:248-677-1421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009583103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist