Provider Demographics
NPI:1417004862
Name:MIDDLIN, JULIE G (AT/ATC, CSCS, CES)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:G
Last Name:MIDDLIN
Suffix:
Gender:F
Credentials:AT/ATC, CSCS, CES
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:G
Other - Last Name:MIDDLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, NCC, LLPC
Mailing Address - Street 1:2040 LEITCH RD
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1510
Mailing Address - Country:US
Mailing Address - Phone:248-266-5616
Mailing Address - Fax:248-605-3525
Practice Address - Street 1:39425 GARFIELD RD STE 23
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038
Practice Address - Country:US
Practice Address - Phone:248-266-5616
Practice Address - Fax:248-605-3525
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL148244101YP2500X
MI2255A2300X
MI6401014131101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer