Healthcare Provider Details

I. General information

NPI: 1194352294
Provider Name (Legal Business Name): JULIE M HARDY PROFESSIONAL COUNSEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7870W US HIGHWAY 2
MANISTIQUE MI
49854-8992
US

IV. Provider business mailing address

315S COUNTY ROAD 442
COOKS MI
49817-9740
US

V. Phone/Fax

Practice location:
  • Phone: 906-341-3200
  • Fax:
Mailing address:
  • Phone: 906-286-0876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401017934
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: