Provider Demographics
NPI:1598046708
Name:TISDALE, JULIA (LMFT)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:TISDALE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6221 GEARY BLVD # US
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-1887
Mailing Address - Country:US
Mailing Address - Phone:650-269-9050
Mailing Address - Fax:
Practice Address - Street 1:42875 GATEWOOD ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-4131
Practice Address - Country:US
Practice Address - Phone:510-656-6438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109508106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist