Provider Demographics
NPI:1063132033
Name:HIEBLER, JULIET BRANDI NICOLE
Entity type:Individual
Prefix:
First Name:JULIET
Middle Name:BRANDI NICOLE
Last Name:HIEBLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 NE DAVIS ST APT 213
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-4435
Mailing Address - Country:US
Mailing Address - Phone:808-640-7969
Mailing Address - Fax:
Practice Address - Street 1:465 NE DAVIS ST APT 213
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-4435
Practice Address - Country:US
Practice Address - Phone:808-640-7969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR8590101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health