Provider Demographics
NPI:1376984617
Name:MACLEAN, JULIA EDEN (LLMSW)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:EDEN
Last Name:MACLEAN
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 W WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-1833
Mailing Address - Country:US
Mailing Address - Phone:517-323-4734
Mailing Address - Fax:517-886-1158
Practice Address - Street 1:2800 W WILLOW ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-1833
Practice Address - Country:US
Practice Address - Phone:517-323-4734
Practice Address - Fax:517-886-1158
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801095396104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker