Provider Demographics
NPI:1659953834
Name:KHOL, JULIE TONG
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:TONG
Last Name:KHOL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:859 LAKEVIEW AVE APT 18
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01850-1042
Mailing Address - Country:US
Mailing Address - Phone:978-942-9833
Mailing Address - Fax:
Practice Address - Street 1:859 LAKEVIEW AVE APT 18
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01850-1042
Practice Address - Country:US
Practice Address - Phone:978-942-9833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician