| Meridian Professional Psychological Consultants | |
|
5031 Park Lake Road East Lansing MI 48823-3835 | |
| (517) 332-0811 | |
| (517) 332-4452 |
| Full Name | Meridian Professional Psychological Consultants |
|---|---|
| Speciality | Substance Abuse Rehabilitation Facility |
| Location | 5031 Park Lake Road, East Lansing, Michigan |
| Authorized Official Name and Position | Barbara Ann Gunnings (DIRECTOR OF OPERATIONS) |
| Authorized Official Contact | 5173320811 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Meridian Professional Psychological Consultants 5031 Park Lake Road East Lansing MI 48823-3835 Ph: (517) 332-0811 | Meridian Professional Psychological Consultants 5031 Park Lake Road East Lansing MI 48823-3835 Ph: (517) 332-0811 |
| NPI Number | 1225150139 |
|---|---|
| Provider Enumeration Date | 04/04/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 5193880284 |
|---|---|
| Medicare Enrollment ID | O20090225000155 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225150139 | NPI | - | NPPES |
| 248226 | Other | MI | CORPORATION |
| 3276326 | Medicaid | MI | |
| 20486 | Other | BLUE CROSS SUB ABUSE | |
| 037146 | Other | VALUE OPTIONS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (Michigan) | Primary |
| 324500000X | Substance Abuse Rehabilitation Facility | 330070 (Michigan) | Primary |
| Provider Name | Leslie G Macauley |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902981103 PECOS PAC ID: 2961303409 Enrollment ID: I20040116000757 |
| Provider Name | Dale A Dmello |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1487751723 PECOS PAC ID: 4183609944 Enrollment ID: I20040624000218 |
| Provider Name | Paul Y Liu |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427014562 PECOS PAC ID: 6709828288 Enrollment ID: I20050525000197 |
| Provider Name | Derrick D Ampey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295761849 PECOS PAC ID: 2668478090 Enrollment ID: I20061009000057 |
| Provider Name | Daniel J Devries |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073558029 PECOS PAC ID: 8426130410 Enrollment ID: I20080130000155 |
| Provider Name | Eugene Pernell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1386764694 PECOS PAC ID: 6901961093 Enrollment ID: I20100121000009 |
| Provider Name | Heather Hawkins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457465908 PECOS PAC ID: 9436345147 Enrollment ID: I20101119001104 |
| Provider Name | Hilton T Thomas |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1700073228 PECOS PAC ID: 6305034315 Enrollment ID: I20101217000208 |
| Provider Name | Jacqualine D Griffin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225225741 PECOS PAC ID: 1850511304 Enrollment ID: I20141003001102 |
| Provider Name | Viola B Mitchell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164619615 PECOS PAC ID: 6406076827 Enrollment ID: I20141007002822 |
| Provider Name | Homer C Hawkins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508053059 PECOS PAC ID: 9931320587 Enrollment ID: I20141023000641 |
| Provider Name | Joseph L Webster |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992827513 PECOS PAC ID: 9830482231 Enrollment ID: I20160722000566 |
| Provider Name | Rose M Cross |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831219195 PECOS PAC ID: 1759675838 Enrollment ID: I20160812000108 |
| Provider Name | Petra Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033667514 PECOS PAC ID: 2961790985 Enrollment ID: I20161006002271 |
| Provider Name | Letisha M Holloway |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043592181 PECOS PAC ID: 8729308366 Enrollment ID: I20161012001801 |
| Provider Name | Michael G Till |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528218328 PECOS PAC ID: 2163582230 Enrollment ID: I20190828000662 |
| Provider Name | Tracey L Green |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295136729 PECOS PAC ID: 7810226065 Enrollment ID: I20190912002483 |
| Provider Name | Joshua Fortney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073854576 PECOS PAC ID: 7719382795 Enrollment ID: I20211013002040 |
| Provider Name | Lisa Doutherd |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1831333509 PECOS PAC ID: 7618312224 Enrollment ID: I20240305000877 |
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