Provider Demographics
NPI:1104203041
Name:HYATT, JULIE (MSMFT, LMFT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:HYATT
Suffix:
Gender:F
Credentials:MSMFT, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 E MADISON PARK APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615
Mailing Address - Country:US
Mailing Address - Phone:847-219-7390
Mailing Address - Fax:
Practice Address - Street 1:1360 E MADISON PARK APT 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-2981
Practice Address - Country:US
Practice Address - Phone:847-219-7390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.001168106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist