Provider Demographics
NPI:1619264652
Name:CHAPPA, JULIE RAE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:RAE
Last Name:CHAPPA
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 1:17063 HACKBERRY LN
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-6885
Mailing Address - Country:US
Mailing Address - Phone:909-708-7313
Mailing Address - Fax:
Practice Address - Street 1:9375 ARCHIBALD AVE STE 311
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5703
Practice Address - Country:US
Practice Address - Phone:909-256-7343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF64059101YM0800X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health