Healthcare Provider Details

I. General information

NPI: 1194930651
Provider Name (Legal Business Name): JUDITH MICHELE STRAIT PSY.D., L.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1683 WHITE OAK LN
INTERLOCHEN MI
49643-9466
US

IV. Provider business mailing address

1683 WHITE OAK LN
INTERLOCHEN MI
49643-9466
US

V. Phone/Fax

Practice location:
  • Phone: 231-944-4176
  • Fax:
Mailing address:
  • Phone: 231-944-4176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301013231
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: