Individual
GLYNN MERRIEWETHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
19321 W CHICAGO ST, DETROIT, MI 48228-1739
(586) 846-6759
Mailing address
24791 PARKSIDE ST APT 206, HARRISON TOWNSHIP, MI 48045-3614
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
103K00000X
Behavior Analyst
—
—
106S00000X
Behavior Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336674415
—
MI
Enumeration date
09/22/2017
Last updated
09/22/2017
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