Provider Demographics
NPI:1447350202
Name:JULIAO, TRACY RENEA (PHD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:RENEA
Last Name:JULIAO
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:PO BOX 3052
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48333-3052
Mailing Address - Country:US
Mailing Address - Phone:734-368-7154
Mailing Address - Fax:
Practice Address - Street 1:23580 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-3241
Practice Address - Country:US
Practice Address - Phone:248-957-6444
Practice Address - Fax:248-477-4442
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2024-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI630101980103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service