Provider Demographics
NPI:1154471860
Name:WHITE, JULIE ANN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:WHITE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1787
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-6787
Mailing Address - Country:US
Mailing Address - Phone:801-698-7059
Mailing Address - Fax:801-593-9445
Practice Address - Street 1:475 N 300 W
Practice Address - Street 2:STE 14
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-3125
Practice Address - Country:US
Practice Address - Phone:801-698-7059
Practice Address - Fax:801-593-9445
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT264212-3501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health