Healthcare Provider Details

I. General information

NPI: 1760699045
Provider Name (Legal Business Name): JULIANNE IRENE NORTH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 WEST ST.
READING MI
49274
US

IV. Provider business mailing address

311 WEST ST.
READING MI
49274
US

V. Phone/Fax

Practice location:
  • Phone: 517-283-1684
  • Fax:
Mailing address:
  • Phone: 517-283-1684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number695883
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: