Provider Demographics
NPI:1962278085
Name:TYMOREK, JULIA R (LPC)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:R
Last Name:TYMOREK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:R
Other - Last Name:TYMOREK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:525 HOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-1526
Mailing Address - Country:US
Mailing Address - Phone:608-213-7517
Mailing Address - Fax:
Practice Address - Street 1:122 E OLIN AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-1487
Practice Address - Country:US
Practice Address - Phone:608-213-7517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10697-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health