Provider Demographics
NPI:1528448750
Name:CHUA, JULIE ANN
Entity type:Individual
Prefix:MS
First Name:JULIE ANN
Middle Name:
Last Name:CHUA
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 1:1682 NOVATO BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-0001
Mailing Address - Country:US
Mailing Address - Phone:415-473-3483
Mailing Address - Fax:
Practice Address - Street 1:1682 NOVATO BLVD STE 105
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-0001
Practice Address - Country:US
Practice Address - Phone:415-473-2721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90354101Y00000X
CA115863106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor