Provider Demographics
NPI:1114394954
Name:O'DONNELL, JULIE ANN (LP)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ANN
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 S BUSINESS HIGHWAY 13
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:64067-1515
Mailing Address - Country:US
Mailing Address - Phone:660-251-6440
Mailing Address - Fax:660-251-6441
Practice Address - Street 1:811 S BUSINESS HIGHWAY 13
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MO
Practice Address - Zip Code:64067-1515
Practice Address - Country:US
Practice Address - Phone:660-251-6440
Practice Address - Fax:660-251-6441
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018012574103T00000X
KS2575103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist