Provider Demographics
NPI:1134380660
Name:MEYERS, MICHELE RENEE
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:RENEE
Last Name:MEYERS
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 1:6159 GABRIELLE AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9840
Mailing Address - Country:US
Mailing Address - Phone:313-283-5482
Mailing Address - Fax:
Practice Address - Street 1:3830 PACKARD ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2051
Practice Address - Country:US
Practice Address - Phone:313-283-5482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI381459362OtherHEALTH ALLIANCE PLAN