Provider Demographics
NPI:1790919470
Name:MICHELL MYERS PC
Entity Type:Organization
Organization Name:MICHELL MYERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:313-283-7423
Mailing Address - Street 1:5543 BISHOP ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-2170
Mailing Address - Country:US
Mailing Address - Phone:313-283-7423
Mailing Address - Fax:313-826-6173
Practice Address - Street 1:5543 BISHOP ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-2170
Practice Address - Country:US
Practice Address - Phone:313-283-7423
Practice Address - Fax:313-826-6173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health