Provider Demographics
NPI:1689113441
Name:MEYER, KIMBERLY JOY
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:JOY
Last Name:MEYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 E 16TH ST STE 255
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-3752
Mailing Address - Country:US
Mailing Address - Phone:616-990-2310
Mailing Address - Fax:616-258-2248
Practice Address - Street 1:675 E 16TH ST STE 255
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-3752
Practice Address - Country:US
Practice Address - Phone:616-990-2310
Practice Address - Fax:616-258-2248
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI247200000X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other