Provider Demographics
NPI:1699301754
Name:CHACON, JULIE KRISTINE (LCSW)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:KRISTINE
Last Name:CHACON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 INDUSTRIAL PARK RD STE 20
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2803
Mailing Address - Country:US
Mailing Address - Phone:385-269-0727
Mailing Address - Fax:
Practice Address - Street 1:931 INDUSTRIAL PARK RD STE 20
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-2803
Practice Address - Country:US
Practice Address - Phone:385-269-0727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-20
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8046438-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical