Provider Demographics
NPI:1225420375
Name:ENTIS, JULIA HEATHER (LCSW)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:HEATHER
Last Name:ENTIS
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 1:810 FERNWOOD PACIFIC DR
Mailing Address - Street 2:
Mailing Address - City:TOPANGA
Mailing Address - State:CA
Mailing Address - Zip Code:90290-3216
Mailing Address - Country:US
Mailing Address - Phone:310-923-1632
Mailing Address - Fax:
Practice Address - Street 1:11928 BEACH CLUB WAY
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-2247
Practice Address - Country:US
Practice Address - Phone:310-923-1632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-26
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA182731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical