Provider Demographics
NPI:1972634517
Name:NGUYEN, JULIE D
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:D
Last Name:NGUYEN
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 1:3131 RED MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-7913
Mailing Address - Country:US
Mailing Address - Phone:713-302-9393
Mailing Address - Fax:281-338-9393
Practice Address - Street 1:424 TARPEY RD
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-3160
Practice Address - Country:US
Practice Address - Phone:713-302-9393
Practice Address - Fax:281-338-9393
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX347781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX611885Medicare ID - Type Unspecified