Provider Demographics
NPI:1760596373
Name:BANGLE, JULIE CATHERINE (LCSW (LINENSED CLINI)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:CATHERINE
Last Name:BANGLE
Suffix:
Gender:F
Credentials:LCSW (LINENSED CLINI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13151 EMILY RD.
Mailing Address - Street 2:SUITE 240
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-8980
Mailing Address - Country:US
Mailing Address - Phone:972-690-7526
Mailing Address - Fax:972-690-3009
Practice Address - Street 1:13151 EMILY RD.
Practice Address - Street 2:SUITE 240
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-8980
Practice Address - Country:US
Practice Address - Phone:972-690-7526
Practice Address - Fax:972-690-3009
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX295541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150901003Medicaid
TX86487QOtherBLUE CROSS BLUE SHIELD
TX86487QOtherBLUE CROSS BLUE SHIELD