Provider Demographics
NPI:1477520757
Name:MATTHEWS, JULIET L (LMHC)
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:L
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 S ROGERS ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-4752
Mailing Address - Country:US
Mailing Address - Phone:812-353-2754
Mailing Address - Fax:812-355-2327
Practice Address - Street 1:1302 S ROGERS ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403
Practice Address - Country:US
Practice Address - Phone:812-353-2754
Practice Address - Fax:812-355-2327
Is Sole Proprietor?:No
Enumeration Date:2006-03-04
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000473A101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000572973OtherANTHEM
000000316251OtherANTHEM