Provider Demographics
NPI:1821508565
Name:KAUFMAN, JULIE ANNE (MA, LPC, RYT-200)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:MA, LPC, RYT-200
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 MAIN ST S STE 290
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-5165
Mailing Address - Country:US
Mailing Address - Phone:651-328-1541
Mailing Address - Fax:
Practice Address - Street 1:324 MAIN ST S STE 290
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-5165
Practice Address - Country:US
Practice Address - Phone:651-328-1541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-09
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1992101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional