Provider Demographics
NPI:1902203029
Name:BYAM, MEIKA
Entity Type:Individual
Prefix:
First Name:MEIKA
Middle Name:
Last Name:BYAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEIKA
Other - Middle Name:
Other - Last Name:LIVERPOOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26045 RED WOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48164-9188
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16250 NORTHLAND DR
Practice Address - Street 2:STE 238
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5205
Practice Address - Country:US
Practice Address - Phone:248-905-5175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-04
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010937561041C0700X
MD198441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical