Provider Demographics
NPI:1336571751
Name:MORENO, JULIE (LLPC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:MORENO
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22523 OLMSTEAD ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2757
Mailing Address - Country:US
Mailing Address - Phone:313-530-4530
Mailing Address - Fax:
Practice Address - Street 1:24750 SWANSON RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-5320
Practice Address - Country:US
Practice Address - Phone:248-355-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013217101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health