Provider Demographics
NPI:1083282495
Name:ANDERSON, JULIE ANN (LMHC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:ALBERT CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50510-0175
Mailing Address - Country:US
Mailing Address - Phone:712-887-0150
Mailing Address - Fax:
Practice Address - Street 1:813 FLINDT DR STE H
Practice Address - Street 2:
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-3206
Practice Address - Country:US
Practice Address - Phone:712-213-2205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-12
Last Update Date:2021-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.003322101YP2500X
IA107964101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional