Healthcare Provider Details

I. General information

NPI: 1962502765
Provider Name (Legal Business Name): JULIE BETH FALBAUM MSW LMSW ACSW CAC-1
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 S MAIN ST
PLYMOUTH MI
48170-2253
US

IV. Provider business mailing address

35216 OLD TIMBER RD
FARMINGTON HILLS MI
48331-1441
US

V. Phone/Fax

Practice location:
  • Phone: 734-451-3440
  • Fax:
Mailing address:
  • Phone: 248-661-6096
  • Fax: 248-737-1587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1-02193
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801057448
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: