Provider Demographics
NPI:1578955480
Name:FADDIS, JULIE (MSCAT, LPC)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:FADDIS
Suffix:
Gender:F
Credentials:MSCAT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6422 W 51ST ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-1678
Mailing Address - Country:US
Mailing Address - Phone:314-719-6737
Mailing Address - Fax:
Practice Address - Street 1:3205 N TWYMAN RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64058-3211
Practice Address - Country:US
Practice Address - Phone:816-249-5377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional