Provider Demographics
NPI:1790723294
Name:SCHUMACHER-COFFEY, JULIE A (PHD)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:A
Last Name:SCHUMACHER-COFFEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5888
Mailing Address - Fax:601-984-5842
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5888
Practice Address - Fax:601-984-5842
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS44-718103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS302I683925OtherMEDICARE PTAN
MS302I685645Medicare PIN
MS512I680002Medicare PIN
MS302I683925OtherMEDICARE PTAN
MSQ31647Medicare UPIN