Provider Demographics
NPI:1568809804
Name:AFFRIME, JULIAN DAVID (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:JULIAN
Middle Name:DAVID
Last Name:AFFRIME
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 GARRETT ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63645-1084
Mailing Address - Country:US
Mailing Address - Phone:573-783-4104
Mailing Address - Fax:573-783-4572
Practice Address - Street 1:309 GARRETT ST
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:MO
Practice Address - Zip Code:63645-1084
Practice Address - Country:US
Practice Address - Phone:573-783-4104
Practice Address - Fax:573-783-4572
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019034783101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional