Provider Demographics
NPI:1225225337
Name:AUSTIN, JULIA E (LCSW)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:E
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CHARLESMEADE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3304
Mailing Address - Country:US
Mailing Address - Phone:731-664-4483
Mailing Address - Fax:
Practice Address - Street 1:150 CHARLESMEADE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3304
Practice Address - Country:US
Practice Address - Phone:731-664-4483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000000021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0063804OtherBLUE CROSS BLUE SHIELD
TN3690006Medicaid
TN0063804OtherBLUE CROSS BLUE SHIELD