Provider Demographics
NPI:1639294994
Name:HOLCOMB, JULIE NATHANSON (MA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:NATHANSON
Last Name:HOLCOMB
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:NATHANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 931404
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90093-1404
Mailing Address - Country:US
Mailing Address - Phone:323-236-6054
Mailing Address - Fax:
Practice Address - Street 1:3171 LOS FELIZ BLVD
Practice Address - Street 2:SUITE 307
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-1527
Practice Address - Country:US
Practice Address - Phone:323-236-6054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC46689106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist