Provider Demographics
NPI:1124226246
Name:PLACENCIA, JULIE ANNE (MS)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANNE
Last Name:PLACENCIA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S GLENOAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1474
Mailing Address - Country:US
Mailing Address - Phone:818-625-6407
Mailing Address - Fax:818-441-0014
Practice Address - Street 1:601 S GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1474
Practice Address - Country:US
Practice Address - Phone:818-625-6407
Practice Address - Fax:818-441-0014
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 51545106H00000X
CA48888106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist