Provider Demographics
NPI:1598380982
Name:CORVELL, JULIANA (MA, TLLP)
Entity Type:Individual
Prefix:
First Name:JULIANA
Middle Name:
Last Name:CORVELL
Suffix:
Gender:F
Credentials:MA, TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5985 W MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-8708
Mailing Address - Country:US
Mailing Address - Phone:269-459-1818
Mailing Address - Fax:
Practice Address - Street 1:5985 W MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-8708
Practice Address - Country:US
Practice Address - Phone:269-459-1818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362008871103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist