Provider Demographics
NPI:1619382488
Name:WEBER, JULIE LYNN (LCPC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:LYNN
Last Name:WEBER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 FORTUNE BOULEVARD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SHILOH
Mailing Address - State:IL
Mailing Address - Zip Code:62269
Mailing Address - Country:US
Mailing Address - Phone:618-401-2496
Mailing Address - Fax:
Practice Address - Street 1:1161 FORTUNE BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62269-7385
Practice Address - Country:US
Practice Address - Phone:618-401-2496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178009360101YP2500X
IL180.009257101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional