Healthcare Provider Details

I. General information

NPI: 1104151950
Provider Name (Legal Business Name): TOTAL HEALTH & WELLNESS ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2009
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31700 W 12 MILE RD SUITE 250
FARMINGTON HILLS MI
48334-4424
US

IV. Provider business mailing address

PO BOX 3052
FARMINGTON HILLS MI
48333-3052
US

V. Phone/Fax

Practice location:
  • Phone: 734-368-7154
  • Fax:
Mailing address:
  • Phone: 734-368-7154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number6301012980
License Number StateMI

VIII. Authorized Official

Name: DR. TRACY RENEA JULIAO
Title or Position: OWNER/LICENSED HEALTH PSYCHOLOGIST
Credential: PH.D.
Phone: 734-368-7154