Healthcare Provider Details

I. General information

NPI: 1841672813
Provider Name (Legal Business Name): JULIE MCKINSTRY WALDRON MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. JULIE ANNE MCKINSTRY

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 W CENTRE AVE STE 211
PORTAGE MI
49024-5344
US

IV. Provider business mailing address

624 S 2ND ST
KALAMAZOO MI
49009-5356
US

V. Phone/Fax

Practice location:
  • Phone: 269-203-5933
  • Fax:
Mailing address:
  • Phone: 269-203-5933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401008024
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301011513
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: