Provider Demographics
NPI:1841438082
Name:MEYER, TINA M (PHD)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:M
Last Name:MEYER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:386 SUMMIT BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-2875
Mailing Address - Country:US
Mailing Address - Phone:248-705-2028
Mailing Address - Fax:
Practice Address - Street 1:386 SUMMIT BLVD
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48362-2875
Practice Address - Country:US
Practice Address - Phone:248-705-2028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012260103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical