Provider Demographics
NPI:1215205885
Name:HILL, URAL HEYWOOD JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:URAL
Middle Name:HEYWOOD
Last Name:HILL
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:RANDI
Other - Middle Name:MICHELE
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD,JD
Mailing Address - Street 1:3913 JACKSON RD
Mailing Address - Street 2:#9
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-1823
Mailing Address - Country:US
Mailing Address - Phone:313-659-8424
Mailing Address - Fax:734-665-2447
Practice Address - Street 1:3913 JACKSON RD
Practice Address - Street 2:#9
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-1823
Practice Address - Country:US
Practice Address - Phone:313-659-8424
Practice Address - Fax:734-665-2447
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012466101YP2500X
GALPC003963101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional