Provider Demographics
NPI:1003956574
Name:CALDWELL, JULIA HOUSIAUX (LICENSEDPSYCHOLOGIST)
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:HOUSIAUX
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:LICENSEDPSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6414 N SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4249
Mailing Address - Country:US
Mailing Address - Phone:414-379-7785
Mailing Address - Fax:
Practice Address - Street 1:823 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-2215
Practice Address - Country:US
Practice Address - Phone:414-379-7785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY104984106H00000X
KY168204103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30615058Medicaid
KY0453Medicare ID - Type UnspecifiedMEDICARE