Provider Demographics
NPI:1023183159
Name:DIAZ, JULIE (LMHP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4485 WESTMINSTER PL
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1812
Mailing Address - Country:US
Mailing Address - Phone:314-610-8477
Mailing Address - Fax:314-535-6632
Practice Address - Street 1:8631 DELMAR BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-1990
Practice Address - Country:US
Practice Address - Phone:314-787-5100
Practice Address - Fax:314-754-2800
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3077101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE23726797209Medicaid