Provider Demographics
NPI:1275607301
Name:PREVOZNIK, JULIE (LPC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:PREVOZNIK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 W SURREY AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-1155
Mailing Address - Country:US
Mailing Address - Phone:602-439-1078
Mailing Address - Fax:602-993-6455
Practice Address - Street 1:11225 N 28TH DR
Practice Address - Street 2:SUITE D215
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-5606
Practice Address - Country:US
Practice Address - Phone:602-993-6077
Practice Address - Fax:602-993-6455
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 0546101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health