Provider Demographics
NPI:1922306604
Name:LESSELYONG, JULIA ANN (PSYD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:ANN
Last Name:LESSELYONG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 N 2ND ST
Mailing Address - Street 2:SUITE 110 #532
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-2422
Mailing Address - Country:US
Mailing Address - Phone:480-442-8510
Mailing Address - Fax:480-907-2130
Practice Address - Street 1:125 N 2ND ST
Practice Address - Street 2:SUITE 110 #532
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-2422
Practice Address - Country:US
Practice Address - Phone:480-442-8510
Practice Address - Fax:480-907-2130
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-04
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4175103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging