Provider Demographics
NPI:1003843319
Name:MUENZENMEYER, MICHELLE MARIE (LLP, CHMC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:MUENZENMEYER
Suffix:
Gender:F
Credentials:LLP, CHMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 E 12300 S STE C-1014
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7976
Mailing Address - Country:US
Mailing Address - Phone:616-795-0900
Mailing Address - Fax:616-795-0899
Practice Address - Street 1:2286 E DEER PARK LN
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-5731
Practice Address - Country:US
Practice Address - Phone:616-795-0900
Practice Address - Fax:616-795-0899
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012595103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP108975200OtherBC/BS