Provider Demographics
NPI:1720139553
Name:LITTLE GROVE, JULIE ANN (MS)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:LITTLE GROVE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:ANN
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 372
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-0372
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 W LINCOLN AVE STE 200
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-2468
Practice Address - Country:US
Practice Address - Phone:217-258-4042
Practice Address - Fax:217-258-4053
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180117867101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional