Provider Demographics
NPI:1265776629
Name:DAVIS, JULIE MEREDITH (LP)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:MEREDITH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5985 W MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-8708
Mailing Address - Country:US
Mailing Address - Phone:269-459-1818
Mailing Address - Fax:269-365-9951
Practice Address - Street 1:5985 W MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009
Practice Address - Country:US
Practice Address - Phone:269-459-1818
Practice Address - Fax:269-365-9951
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-23
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014418103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty