Provider Demographics
NPI:1508363839
Name:CHACON, JULIE ANN (MED)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:CHACON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 LANAY ST
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353-6061
Mailing Address - Country:US
Mailing Address - Phone:509-554-0364
Mailing Address - Fax:
Practice Address - Street 1:412 W CLARK ST
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-5629
Practice Address - Country:US
Practice Address - Phone:509-460-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60152490101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor