Provider Demographics
NPI:1447407838
Name:FORD, JULIE C (MFT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:C
Last Name:FORD
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 N OLD WORLD 3RD ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53203-1100
Mailing Address - Country:US
Mailing Address - Phone:262-221-3971
Mailing Address - Fax:
Practice Address - Street 1:1110 N OLD WORLD 3RD ST
Practice Address - Street 2:SUITE 410
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53203-1100
Practice Address - Country:US
Practice Address - Phone:262-221-3971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33456106H00000X
WI912-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist