Healthcare Provider Details

I. General information

NPI: 1093670655
Provider Name (Legal Business Name): JULIA NELSON MDIV, MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 RIVER ST STE 201
MANISTEE MI
49660-2729
US

IV. Provider business mailing address

14613 WUOKSI AVE
KALEVA MI
49645-9307
US

V. Phone/Fax

Practice location:
  • Phone: 231-714-0282
  • Fax:
Mailing address:
  • Phone: 231-714-4457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401225838
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: