Provider Demographics
NPI:1194935916
Name:MINKEL, JULIETTE SMITH (MS, MED, LPC,RPT-S)
Entity type:Individual
Prefix:MS
First Name:JULIETTE
Middle Name:SMITH
Last Name:MINKEL
Suffix:
Gender:F
Credentials:MS, MED, LPC,RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 W CLEBURN ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-1918
Mailing Address - Country:US
Mailing Address - Phone:479-236-5631
Mailing Address - Fax:479-527-6706
Practice Address - Street 1:216 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-5959
Practice Address - Country:US
Practice Address - Phone:479-236-5631
Practice Address - Fax:479-527-6706
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP9609022101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor