Provider Demographics
NPI:1063813491
Name:GREENWELL, JULIE MARIE (MA)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:GREENWELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2823 FRANKFORT AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2639
Mailing Address - Country:US
Mailing Address - Phone:502-893-0241
Mailing Address - Fax:502-212-1293
Practice Address - Street 1:2823 FRANKFORT AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2639
Practice Address - Country:US
Practice Address - Phone:502-893-0241
Practice Address - Fax:502-212-1293
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0115103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent