Provider Demographics
NPI:1114330768
Name:BOESEN, JULIE (PHD)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:BOESEN
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 1:1810 COMMERCE ST
Mailing Address - Street 2:418
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-5346
Mailing Address - Country:US
Mailing Address - Phone:512-903-1319
Mailing Address - Fax:
Practice Address - Street 1:1810 COMMERCE ST
Practice Address - Street 2:418
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-5346
Practice Address - Country:US
Practice Address - Phone:512-903-1319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35179103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist