Individual
DR. MYRTLE CHARISSE MEANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
23003 GREATER MACK AVE STE B, SAINT CLAIR SHORES, MI 48080-1965
(313) 574-6616
Mailing address
11285 ELKINS RD STE D3, ROSWELL, GA 30076-5835
(313) 574-6616
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301011889
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
68OE017280
BCBS
MI
Enumeration date
09/20/2006
Last updated
08/26/2019
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