Basic Information
| Provider Information | |||||||||
| NPI: | 1023755998 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRICE | ||||||||
| FirstName: | MEGAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25564 LORD DR | ||||||||
| Address2: | |||||||||
| City: | CHESTERFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480513207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5866104733 | ||||||||
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| Practice Location | |||||||||
| Address1: | 625 KENMOOR AVE SE STE 215 | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495462395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6168053660 | ||||||||
| FaxNumber: | 6168053631 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2022 | ||||||||
| LastUpdateDate: | 05/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TA0400X | 6352000648 | MI | N | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | 103TA0700X | 6352000648 | MI | N | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging | 103TB0200X | 6352000648 | MI | N | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 103TC0700X | 6352000648 | MI | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC1900X | 6352000648 | MI | N | Behavioral Health & Social Service Providers | Psychologist | Counseling | 103TC2200X | 6352000648 | MI | N | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 103TF0000X | 6352000648 | MI | N | Behavioral Health & Social Service Providers | Psychologist | Family | 103TH0004X | 6352000648 | MI | N | Behavioral Health & Social Service Providers | Psychologist | Health | 103TM1800X | 6352000648 | MI | N | Behavioral Health & Social Service Providers | Psychologist | Mental Retardation & Developmental Disabilities | 103TP0814X | 6352000648 | MI | N | Behavioral Health & Social Service Providers | Psychologist | Psychoanalysis | 103TP2701X | 6352000648 | MI | N | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | 103TR0400X | 6352000648 | MI | N | Behavioral Health & Social Service Providers | Psychologist | Rehabilitation | 103TS0200X | 6352000648 | MI | N | Behavioral Health & Social Service Providers | Psychologist | School | 103T00000X | 6352000648 | MI | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.