Provider Demographics
NPI:1760692974
Name:SELLERS, JULIE A (BS, CPP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:SELLERS
Suffix:
Gender:F
Credentials:BS, CPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 E JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2905
Mailing Address - Country:US
Mailing Address - Phone:574-234-6024
Mailing Address - Fax:574-234-6025
Practice Address - Street 1:818 E JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2905
Practice Address - Country:US
Practice Address - Phone:574-234-6024
Practice Address - Fax:574-234-6025
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCPP332171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator