Provider Demographics
NPI:1790317881
Name:ELLENDER, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:ELLENDER
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 1:2517 ENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-3715
Mailing Address - Country:US
Mailing Address - Phone:512-900-1425
Mailing Address - Fax:866-302-4553
Practice Address - Street 1:2517 ENFIELD RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-3715
Practice Address - Country:US
Practice Address - Phone:512-900-1425
Practice Address - Fax:866-302-4553
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3207103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst