Provider Demographics
NPI:1710081179
Name:VANN, JULIE BETH (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:BETH
Last Name:VANN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2763 DENA DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904
Mailing Address - Country:US
Mailing Address - Phone:325-655-4790
Mailing Address - Fax:325-655-4790
Practice Address - Street 1:17 S CHADBOURNE ST
Practice Address - Street 2:SUITE 206
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-5862
Practice Address - Country:US
Practice Address - Phone:325-655-4790
Practice Address - Fax:325-655-4790
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13141101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3273LCOtherBLUE CROSS BLUE SHIELD
TX027366601Medicaid