Provider Demographics
NPI:1427280361
Name:WOODWORTH, JULIE ANN (MS LLP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:WOODWORTH
Suffix:
Gender:F
Credentials:MS LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 N INGALLS ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-1595
Mailing Address - Country:US
Mailing Address - Phone:818-652-5629
Mailing Address - Fax:
Practice Address - Street 1:17352 W 12 MILE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2119
Practice Address - Country:US
Practice Address - Phone:248-559-0730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006430106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4101006430OtherDEPARTMENT OF COMMUNITY HEALTH