Provider Demographics
NPI:1750832069
Name:MY THERAPIST JULIE, INC.
Entity Type:Organization
Organization Name:MY THERAPIST JULIE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:GODDARD
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:813-858-7663
Mailing Address - Street 1:1710 W FORE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-5022
Mailing Address - Country:US
Mailing Address - Phone:813-858-7663
Mailing Address - Fax:239-307-2395
Practice Address - Street 1:3825 HENDERSON BLVD
Practice Address - Street 2:SUITE 405
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-5037
Practice Address - Country:US
Practice Address - Phone:813-858-7663
Practice Address - Fax:239-307-2395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11025101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty