Provider Demographics
NPI:1376221523
Name:PROULX, JHULIET MIKAEL
Entity Type:Individual
Prefix:
First Name:JHULIET
Middle Name:MIKAEL
Last Name:PROULX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JHULIET
Other - Middle Name:
Other - Last Name:MIKAELIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1146 N CENTRAL AVE STE 621
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2506
Mailing Address - Country:US
Mailing Address - Phone:818-925-2410
Mailing Address - Fax:818-925-2411
Practice Address - Street 1:327 ARDEN AVE SUITE 201
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203
Practice Address - Country:US
Practice Address - Phone:818-925-2410
Practice Address - Fax:818-925-2411
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA137910106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist