Provider Demographics
NPI:1114610417
Name:JULIAN, CALLIE GRACE (RBT)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:GRACE
Last Name:JULIAN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 S JEFFERSON AVE APT L1
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-5561
Mailing Address - Country:US
Mailing Address - Phone:931-644-7791
Mailing Address - Fax:
Practice Address - Street 1:206 S JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4748
Practice Address - Country:US
Practice Address - Phone:931-283-2919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician