Provider Demographics
NPI:1710128343
Name:PREWITT, JULIE ANNETTE (LBSW)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANNETTE
Last Name:PREWITT
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 W. LAMAR ST.
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-4014
Mailing Address - Country:US
Mailing Address - Phone:409-384-6829
Mailing Address - Fax:409-384-4770
Practice Address - Street 1:139 W. LAMAR ST.
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-4014
Practice Address - Country:US
Practice Address - Phone:409-384-6829
Practice Address - Fax:409-384-4770
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52483171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator