Provider Demographics
NPI:1346543600
Name:CHEETHAM, JULIE (LBSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:CHEETHAM
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2454 N CASA NUEVA CIR
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-1113
Mailing Address - Country:US
Mailing Address - Phone:520-251-8986
Mailing Address - Fax:
Practice Address - Street 1:900 E FLORENCE BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4666
Practice Address - Country:US
Practice Address - Phone:520-836-4278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLBSW13156101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health