Healthcare Provider Details

I. General information

NPI: 1811710668
Provider Name (Legal Business Name): PREMO PSYCHOLOGICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 CARRIAGE WAY
YPSILANTI MI
48197-7449
US

IV. Provider business mailing address

455 E EISENHOWER PKWY SUITE 300 PMB1166
ANN ARBOR MI
48108-3324
US

V. Phone/Fax

Practice location:
  • Phone: 734-249-2282
  • Fax:
Mailing address:
  • Phone: 734-249-2282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JULIE E PREMO
Title or Position: OWNER/CLINICAL PSYCHOLOGIST
Credential: PHD, LP
Phone: 734-249-8828