Provider Demographics
NPI:1477065159
Name:BLANK, JULIETTE CHLOE (LPCC, LMHC)
Entity Type:Individual
Prefix:
First Name:JULIETTE
Middle Name:CHLOE
Last Name:BLANK
Suffix:
Gender:F
Credentials:LPCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 S JACKSON ST STE 301
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2872
Mailing Address - Country:US
Mailing Address - Phone:415-325-2855
Mailing Address - Fax:
Practice Address - Street 1:108 S JACKSON ST STE 301
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2872
Practice Address - Country:US
Practice Address - Phone:415-325-2855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-02
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YP2500X
CA8284101YP2500X
WA61123929101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty