Provider Demographics
NPI:1326452970
Name:BEAUVAIS-NIEZURAWSKI, JUSTINE ALEXANDRA
Entity Type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:ALEXANDRA
Last Name:BEAUVAIS-NIEZURAWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 W SOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-1611
Mailing Address - Country:US
Mailing Address - Phone:800-693-1916
Mailing Address - Fax:
Practice Address - Street 1:89 W SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085
Practice Address - Country:US
Practice Address - Phone:800-693-1916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016349103T00000X, 103TC1900X
MI6361001388103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling