Provider Demographics
NPI:1063521763
Name:KELLY, JULIE C (MSW)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:C
Last Name:KELLY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:EDINGER
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:2548 CASTLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-6110
Mailing Address - Country:US
Mailing Address - Phone:916-487-5845
Mailing Address - Fax:
Practice Address - Street 1:3307 BROADWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2821
Practice Address - Country:US
Practice Address - Phone:916-454-4242
Practice Address - Fax:916-454-2930
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional