Provider Demographics
NPI:1033202940
Name:EVANS WATKINS, JULIE A (PHD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:EVANS WATKINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 SW MADISON AVE STE 116
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4739
Mailing Address - Country:US
Mailing Address - Phone:541-295-0157
Mailing Address - Fax:
Practice Address - Street 1:260 SW MADISON AVE STE 116
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4739
Practice Address - Country:US
Practice Address - Phone:541-295-0157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1668103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR133113Medicare ID - Type Unspecified