Provider Demographics
NPI:1518065697
Name:FESSENDEN, JULIE ANN (MFT)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:FESSENDEN
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 1:740 W TEXAS ST
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-5558
Mailing Address - Country:US
Mailing Address - Phone:707-422-8612
Mailing Address - Fax:
Practice Address - Street 1:740 W TEXAS ST
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5558
Practice Address - Country:US
Practice Address - Phone:707-422-8612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT28392106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist