Provider Demographics
NPI:1043785371
Name:VICKERS, JULIA RENEE (MA, ALMFT)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:RENEE
Last Name:VICKERS
Suffix:
Gender:F
Credentials:MA, ALMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 ULULANI ST
Mailing Address - Street 2:
Mailing Address - City:KULA
Mailing Address - State:HI
Mailing Address - Zip Code:96790-8930
Mailing Address - Country:US
Mailing Address - Phone:801-675-8082
Mailing Address - Fax:
Practice Address - Street 1:49 ULULANI ST
Practice Address - Street 2:
Practice Address - City:KULA
Practice Address - State:HI
Practice Address - Zip Code:96790-8930
Practice Address - Country:US
Practice Address - Phone:801-675-8082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-13
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.001569106H00000X
IL208.000643106H00000X
HIMFT-824-0106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist