Provider Demographics
NPI:1346392677
Name:MANNING, JULIE (PSY MALLP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:MANNING
Suffix:
Gender:F
Credentials:PSY MALLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6443 INKSTER RD
Mailing Address - Street 2:STE 265
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-1318
Mailing Address - Country:US
Mailing Address - Phone:248-515-2704
Mailing Address - Fax:
Practice Address - Street 1:6443 INKSTER RD
Practice Address - Street 2:STE 265
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48301-1318
Practice Address - Country:US
Practice Address - Phone:248-515-2704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJM008332103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist