Provider Demographics
NPI:1609933894
Name:BERNHARD, JULIE ANN (MA LLP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:BERNHARD
Suffix:
Gender:F
Credentials:MA LLP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:KACHADURIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:2550 S TELEGRAPH RD STE 250
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0909
Mailing Address - Country:US
Mailing Address - Phone:248-322-0001
Mailing Address - Fax:
Practice Address - Street 1:2550 S TELEGRAPH RD STE 250
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0909
Practice Address - Country:US
Practice Address - Phone:248-322-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361001198103TA0400X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6361001198OtherDEPARTMENT OF LICENSING AND REGULATORY AFFAIRS BOARD OF PSYCHOLOGY, MASTER'S LLP