Provider Demographics
NPI:1376360214
Name:MILLER, JULIE ANNE (BSA)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:MILLER
Suffix:
Gender:F
Credentials:BSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 WOODWARD AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2136
Mailing Address - Country:US
Mailing Address - Phone:845-416-1432
Mailing Address - Fax:
Practice Address - Street 1:8801 WOODWARD AVE STE 206
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2136
Practice Address - Country:US
Practice Address - Phone:845-416-1432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty