Provider Demographics
NPI:1922447622
Name:MCLEAN, JULIA S (MFT)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:S
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2672 BAYSHORE PKWY
Mailing Address - Street 2:SUITE 1045
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-1001
Mailing Address - Country:US
Mailing Address - Phone:650-265-4288
Mailing Address - Fax:
Practice Address - Street 1:2672 BAYSHORE PKWY
Practice Address - Street 2:SUITE 1045
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-1001
Practice Address - Country:US
Practice Address - Phone:650-265-4288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 37241106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA50129OtherMUNICIPAL BUSINESS LICENSE CITY OF MOUNTAIN VIEW
CAMFC 37241OtherMARRIAGE AND FAMILY THERAPIST LICENSE NUMBER - CA BBS