Provider Demographics
NPI:1376050286
Name:CLOSIUS, JUDY (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:CLOSIUS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8084 LONGMEADOW LN
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-9346
Mailing Address - Country:US
Mailing Address - Phone:734-780-5598
Mailing Address - Fax:
Practice Address - Street 1:302 N HURON ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2947
Practice Address - Country:US
Practice Address - Phone:734-780-5598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007951101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional