Provider Demographics
NPI:1609933894
Name:BERNHARD, JULIE ANN (MA LLP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:BERNHARD
Suffix:
Gender:F
Credentials:MA LLP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:KACHADURIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:6773 W MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3030
Mailing Address - Country:US
Mailing Address - Phone:248-661-6100
Mailing Address - Fax:
Practice Address - Street 1:6773 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3013
Practice Address - Country:US
Practice Address - Phone:248-788-3037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007174103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP108978660OtherBLUE CROSS BLUE SHIELD