Provider Demographics
NPI:1396851598
Name:ODONNELL, JULIE ANN (LCPC)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANN
Last Name:ODONNELL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606A EASTGATE ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-3304
Mailing Address - Country:US
Mailing Address - Phone:618-549-6984
Mailing Address - Fax:618-549-9614
Practice Address - Street 1:606A EASTGATE ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-3304
Practice Address - Country:US
Practice Address - Phone:618-549-6984
Practice Address - Fax:618-549-9614
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01630029OtherBLUE CROSS/BLUE SHIELD