Provider Demographics
NPI:1811710668
Name:PREMO PSYCHOLOGICAL SERVICES PLLC
Entity type:Organization
Organization Name:PREMO PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:PREMO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP
Authorized Official - Phone:734-249-8828
Mailing Address - Street 1:455 E EISENHOWER PKWY
Mailing Address - Street 2:SUITE 300 PMB1166
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-3324
Mailing Address - Country:US
Mailing Address - Phone:734-249-2282
Mailing Address - Fax:
Practice Address - Street 1:339 CARRIAGE WAY
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-7449
Practice Address - Country:US
Practice Address - Phone:734-249-2282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-31
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health