Provider Demographics
NPI:1245390012
Name:BINGHAM, JULIE EVANS (PHD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:EVANS
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 COTTAGE ST NE
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3811
Mailing Address - Country:US
Mailing Address - Phone:503-584-9924
Mailing Address - Fax:503-584-0303
Practice Address - Street 1:528 COTTAGE ST NE
Practice Address - Street 2:SUITE 1D
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3811
Practice Address - Country:US
Practice Address - Phone:503-584-9924
Practice Address - Fax:503-584-0303
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1523103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent