Provider Demographics
NPI:1881229540
Name:PREMO, JULIE (PHD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
Last Name:PREMO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 E EISENHOWER PKWY
Mailing Address - Street 2:STE 300 #1166
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-3324
Mailing Address - Country:US
Mailing Address - Phone:734-249-8828
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:734-249-8828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301017860103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical