Provider Demographics
NPI:1659774289
Name:GALVIN, JULIE A (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:A
Last Name:GALVIN
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38349 CHURCHILL LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-3781
Mailing Address - Country:US
Mailing Address - Phone:734-323-4897
Mailing Address - Fax:
Practice Address - Street 1:38349 CHURCHILL LN
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-3781
Practice Address - Country:US
Practice Address - Phone:734-323-4897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013912103T00000X
MISP000035103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool