Provider Demographics
NPI:1275084451
Name:RICHARDSON, JULIE (LPCA)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 FAIRWAY ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-2452
Mailing Address - Country:US
Mailing Address - Phone:270-904-6307
Mailing Address - Fax:270-904-6314
Practice Address - Street 1:1143 FAIRWAY ST
Practice Address - Street 2:SUITE 103
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-2452
Practice Address - Country:US
Practice Address - Phone:270-904-6307
Practice Address - Fax:270-904-6314
Is Sole Proprietor?:No
Enumeration Date:2016-10-21
Last Update Date:2016-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1391101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY101YM0800XMedicaid