Provider Demographics
NPI:1437348836
Name:FAMBRO, JULIE GRIFFIN (PHD, LP, LSSP)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:GRIFFIN
Last Name:FAMBRO
Suffix:
Gender:F
Credentials:PHD, LP, LSSP
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:DENISE
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LP, LSSP
Mailing Address - Street 1:4995 COUNTY ROAD 513
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-6851
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4995 COUNTY ROAD 513
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-6851
Practice Address - Country:US
Practice Address - Phone:512-914-1362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33159103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist