Provider Demographics
NPI:1841672813
Name:WALDRON, JULIE MCKINSTRY (MA)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:MCKINSTRY
Last Name:WALDRON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:ANNE
Other - Last Name:MCKINSTRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:624 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-5356
Mailing Address - Country:US
Mailing Address - Phone:269-203-5933
Mailing Address - Fax:
Practice Address - Street 1:5955 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-8700
Practice Address - Country:US
Practice Address - Phone:269-203-5933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-25
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011513103TC1900X
MI6401008024101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling