Provider Demographics
NPI:1770849945
Name:CARLSON, JULIE ANN
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANN
Last Name:CARLSON
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:PO BOX 2651
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92263-2651
Mailing Address - Country:US
Mailing Address - Phone:760-288-4579
Mailing Address - Fax:769-288-3752
Practice Address - Street 1:19531 MCLANE ST., SUITE B, PALM SPRINGS, CA 92240
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262
Practice Address - Country:US
Practice Address - Phone:760-288-4579
Practice Address - Fax:760-288-3752
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator