Provider Demographics
NPI:1124006895
Name:MEYERS, JACQUELINE ADELINE (PSYD, LP, LPC, NCC)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:ADELINE
Last Name:MEYERS
Suffix:
Gender:F
Credentials:PSYD, LP, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3247 BIDDLE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-5951
Mailing Address - Country:US
Mailing Address - Phone:734-991-3234
Mailing Address - Fax:
Practice Address - Street 1:2955 BIDDLE AVE STE 200
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-5231
Practice Address - Country:US
Practice Address - Phone:734-991-3234
Practice Address - Fax:734-324-1566
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008214101YP2500X
MI6301015288103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional