Provider Demographics
NPI:1386370005
Name:BEAUFEAUX, JULIE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:BEAUFEAUX
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 1:12850 96TH ST NE # T
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MN
Mailing Address - Zip Code:55330-7389
Mailing Address - Country:US
Mailing Address - Phone:612-201-8508
Mailing Address - Fax:
Practice Address - Street 1:12850 96TH ST NE # T
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MN
Practice Address - Zip Code:55330-7389
Practice Address - Country:US
Practice Address - Phone:612-201-8508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN168851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty