Provider Demographics
NPI:1083700744
Name:GAUT, JULIANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:
Last Name:GAUT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#12 MEDICAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106
Mailing Address - Country:US
Mailing Address - Phone:806-356-0404
Mailing Address - Fax:806-356-0590
Practice Address - Street 1:#12 MEDICAL DRIVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106
Practice Address - Country:US
Practice Address - Phone:806-356-0404
Practice Address - Fax:806-356-0590
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX327391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5454268Medicare UPIN
TX7881338Medicare UPIN
TX0031HNMedicare UPIN
00453PMedicare ID - Type Unspecified