Provider Demographics
NPI:1225041551
Name:DAVIS, JULIA ---- (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:----
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 OAK GROVE ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3253
Mailing Address - Country:US
Mailing Address - Phone:612-871-8684
Mailing Address - Fax:612-871-2374
Practice Address - Street 1:430 OAK GROVE ST
Practice Address - Street 2:SUITE 403
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3253
Practice Address - Country:US
Practice Address - Phone:612-871-8684
Practice Address - Fax:612-871-2374
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1216103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1329511OtherSTATE IDENTIFICATION #