Provider Demographics
NPI:1962053447
Name:IMMEL, MEGHAN LAWLER
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:LAWLER
Last Name:IMMEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47431 ST. HWY M26 UNIT 1, SUITE 2
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931
Mailing Address - Country:US
Mailing Address - Phone:906-523-7172
Mailing Address - Fax:906-523-7171
Practice Address - Street 1:47431 ST. HWY M26 UNIT 1, SUITE 2
Practice Address - Street 2:
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931
Practice Address - Country:US
Practice Address - Phone:906-523-7172
Practice Address - Fax:906-523-7171
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YA0400X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)