Provider Demographics
NPI:1104151950
Name:TOTAL HEALTH & WELLNESS ASSOCIATES
Entity type:Organization
Organization Name:TOTAL HEALTH & WELLNESS ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED HEALTH PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:RENEA
Authorized Official - Last Name:JULIAO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:734-368-7154
Mailing Address - Street 1:PO BOX 3052
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48333-3052
Mailing Address - Country:US
Mailing Address - Phone:734-368-7154
Mailing Address - Fax:
Practice Address - Street 1:31700 W 12 MILE RD
Practice Address - Street 2:SUITE 250
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-4424
Practice Address - Country:US
Practice Address - Phone:734-368-7154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012980103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Single Specialty