Healthcare Provider Details

I. General information

NPI: 1871002444
Provider Name (Legal Business Name): JULIE WEISS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 BIRCH LN
GROSSE POINTE WOODS MI
48236-2461
US

IV. Provider business mailing address

644 BIRCH LN
GROSSE POINTE WOODS MI
48236-2461
US

V. Phone/Fax

Practice location:
  • Phone: 313-595-2968
  • Fax:
Mailing address:
  • Phone: 313-595-2968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401013360
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401013360
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: