Provider Demographics
NPI:1588877146
Name:MEINKE, SUZANNE CHRISTINE (MA, LPC, LMFT, NCC)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:CHRISTINE
Last Name:MEINKE
Suffix:
Gender:F
Credentials:MA, LPC, LMFT, NCC
Other - Prefix:MISS
Other - First Name:SUZANNE
Other - Middle Name:CHRISTINE
Other - Last Name:DEVYLDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:2618 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-1412
Mailing Address - Country:US
Mailing Address - Phone:269-352-8341
Mailing Address - Fax:
Practice Address - Street 1:6963 W KL AVE STE A
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-8043
Practice Address - Country:US
Practice Address - Phone:269-459-9790
Practice Address - Fax:269-459-9791
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2019-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YA0400X
MI4101006447106H00000X
MI6401011616101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist