Provider Demographics
NPI:1235521311
Name:JULIE B JAEKEL LCSW
Entity Type:Organization
Organization Name:JULIE B JAEKEL LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:JAEKEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:850-212-2817
Mailing Address - Street 1:1225 J G LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-5768
Mailing Address - Country:US
Mailing Address - Phone:850-212-2817
Mailing Address - Fax:
Practice Address - Street 1:1225 J G LN
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-5768
Practice Address - Country:US
Practice Address - Phone:850-212-2817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty