Provider Demographics
NPI:1508478181
Name:PARK, JULIA (LMSW)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:SCHWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2595 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-5905
Mailing Address - Country:US
Mailing Address - Phone:901-842-3160
Mailing Address - Fax:901-842-2360
Practice Address - Street 1:2595 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-5905
Practice Address - Country:US
Practice Address - Phone:901-842-3160
Practice Address - Fax:901-842-2360
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6820104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty