Healthcare Provider Details

I. General information

NPI: 1407337595
Provider Name (Legal Business Name): JULIE THOMASON LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 N CLARE AVE
HARRISON MI
48625-8250
US

IV. Provider business mailing address

5957 S MISSION RD
MOUNT PLEASANT MI
48858-9191
US

V. Phone/Fax

Practice location:
  • Phone: 989-539-2141
  • Fax:
Mailing address:
  • Phone: 734-657-3486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6801103234
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: