Provider Demographics
NPI:1124385216
Name:SHAULL, JULIA F (LCSW, BCBA)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:F
Last Name:SHAULL
Suffix:
Gender:F
Credentials:LCSW, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2082 BUSINESS CENTER DR
Mailing Address - Street 2:#282
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-1129
Mailing Address - Country:US
Mailing Address - Phone:949-250-1101
Mailing Address - Fax:
Practice Address - Street 1:2082 BUSINESS CENTER DR
Practice Address - Street 2:#282
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1129
Practice Address - Country:US
Practice Address - Phone:949-250-1101
Practice Address - Fax:949-250-1103
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-04-1576103K00000X
CALCS105621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical