Provider Demographics
NPI:1215242029
Name:HUSSMAN, JULIE (HUSSMAN JULIE)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:HUSSMAN
Suffix:
Gender:F
Credentials:HUSSMAN JULIE
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:GALANTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 1043
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92652-1043
Mailing Address - Country:US
Mailing Address - Phone:949-544-5802
Mailing Address - Fax:
Practice Address - Street 1:332 FOREST AVE
Practice Address - Street 2:SUITE 26
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2117
Practice Address - Country:US
Practice Address - Phone:949-544-5802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47739106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist