Provider Demographics
NPI:1962787929
Name:SHORE, JULIANE TAYLOR (LPC, LMFTA)
Entity type:Individual
Prefix:MS
First Name:JULIANE
Middle Name:TAYLOR
Last Name:SHORE
Suffix:
Gender:F
Credentials:LPC, LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 MANCHACA RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-6631
Mailing Address - Country:US
Mailing Address - Phone:512-653-0564
Mailing Address - Fax:512-443-4844
Practice Address - Street 1:3625 MANCHACA RD
Practice Address - Street 2:SUITE 102
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-6631
Practice Address - Country:US
Practice Address - Phone:512-653-0564
Practice Address - Fax:512-443-4844
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65532101YP2500X
TX201454106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist