Provider Demographics
NPI:1578068581
Name:JULIE A. STATES, PHD, PLLC
Entity Type:Organization
Organization Name:JULIE A. STATES, PHD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:STATES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:814-238-1880
Mailing Address - Street 1:229 W FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-4823
Mailing Address - Country:US
Mailing Address - Phone:814-238-1880
Mailing Address - Fax:814-867-2794
Practice Address - Street 1:229 W FOSTER AVE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-4823
Practice Address - Country:US
Practice Address - Phone:814-238-1880
Practice Address - Fax:814-867-2794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS0105297251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA617791Medicaid