Provider Demographics
NPI:1104663442
Name:SAMPLE, JULIANNE (LPC)
Entity type:Individual
Prefix:MRS
First Name:JULIANNE
Middle Name:
Last Name:SAMPLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5416 W COLES RD
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-7143
Mailing Address - Country:US
Mailing Address - Phone:303-359-4539
Mailing Address - Fax:
Practice Address - Street 1:2990 N LITCHFIELD RD STE 7
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-7800
Practice Address - Country:US
Practice Address - Phone:602-842-2754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-12
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-23159101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health