1093060022 NPI number — MS. DONNA L. MELDRUM MA, LPC, NCC

Table of content: MS. DONNA L. MELDRUM MA, LPC, NCC (NPI 1093060022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093060022 NPI number — MS. DONNA L. MELDRUM MA, LPC, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MELDRUM
Provider First Name:
DONNA
Provider Middle Name:
L.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC, NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093060022
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
117 CASS AVENUE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
MT. CLEMENS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-260-7835
Provider Business Mailing Address Fax Number:
586-468-5270

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 CASS AVE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
MOUNT CLEMENS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48043-2252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-260-7835
Provider Business Practice Location Address Fax Number:
586-468-5270
Provider Enumeration Date:
07/16/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  6401011811 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: 6401011811 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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