Healthcare Provider Details

I. General information

NPI: 1285997023
Provider Name (Legal Business Name): JULIE L EDWARDS LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 E BELTLINE AVE NE
GRAND RAPIDS MI
49525-8614
US

IV. Provider business mailing address

2050 BRETON RD SE STE 104
GRAND RAPIDS MI
49546-5547
US

V. Phone/Fax

Practice location:
  • Phone: 616-267-8269
  • Fax:
Mailing address:
  • Phone: 616-227-0806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301015050
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: