Provider Demographics
NPI:1316576911
Name:JULY, MARVEL LIONEL
Entity Type:Individual
Prefix:
First Name:MARVEL
Middle Name:LIONEL
Last Name:JULY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 TIERRA HUICHOL CIR
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:NM
Mailing Address - Zip Code:88021-8262
Mailing Address - Country:US
Mailing Address - Phone:714-401-1576
Mailing Address - Fax:
Practice Address - Street 1:1151 TIERRA HUICHOL CIR
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:NM
Practice Address - Zip Code:88021-8262
Practice Address - Country:US
Practice Address - Phone:714-401-1576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst