Provider Demographics
NPI:1427291988
Name:WILSON, JULIANNE ELIZABETH (LMHC)
Entity type:Individual
Prefix:MRS
First Name:JULIANNE
Middle Name:ELIZABETH
Last Name:WILSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 E CASINO RD STE A
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-2628
Mailing Address - Country:US
Mailing Address - Phone:425-293-1610
Mailing Address - Fax:
Practice Address - Street 1:906 SE EVERETT MALL WAY
Practice Address - Street 2:STE 200
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-3743
Practice Address - Country:US
Practice Address - Phone:425-353-5656
Practice Address - Fax:425-513-2807
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00009788101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2078083Medicaid