Provider Demographics
NPI:1194930651
Name:STRAIT, JUDITH MICHELE (PSYD, LP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:MICHELE
Last Name:STRAIT
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1683 WHITE OAK LN
Mailing Address - Street 2:
Mailing Address - City:INTERLOCHEN
Mailing Address - State:MI
Mailing Address - Zip Code:49643-9466
Mailing Address - Country:US
Mailing Address - Phone:231-944-4176
Mailing Address - Fax:
Practice Address - Street 1:1683 WHITE OAK LN
Practice Address - Street 2:
Practice Address - City:INTERLOCHEN
Practice Address - State:MI
Practice Address - Zip Code:49643-9466
Practice Address - Country:US
Practice Address - Phone:231-944-4176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013231103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical