Provider Demographics
NPI:1346855673
Name:GOMEZ, JULIA GA
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:GA
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 747
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66505-0747
Mailing Address - Country:US
Mailing Address - Phone:785-587-4300
Mailing Address - Fax:
Practice Address - Street 1:1558 HAYES DRIVE
Practice Address - Street 2:MAILING ADDRESS 2
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-6650
Practice Address - Country:US
Practice Address - Phone:785-587-4315
Practice Address - Fax:785-587-4363
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS51291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical