Provider Demographics
NPI:1710494653
Name:CHAVEZ, JULIE A
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:CHAVEZ
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 1:102 ALLEGHENY WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-3026
Mailing Address - Country:US
Mailing Address - Phone:907-378-0357
Mailing Address - Fax:
Practice Address - Street 1:102 ALLEGHENY WAY
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3026
Practice Address - Country:US
Practice Address - Phone:907-378-0357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-31
Last Update Date:2017-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKRBT-16-18946106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician