Provider Demographics
NPI:1104683101
Name:GILLETTE, JULIE C
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:C
Last Name:GILLETTE
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 1:5815 E LA PALMA AVE SPC 303
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-2250
Mailing Address - Country:US
Mailing Address - Phone:714-353-0640
Mailing Address - Fax:
Practice Address - Street 1:1940 S BEDFORD ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-1308
Practice Address - Country:US
Practice Address - Phone:831-946-9063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health