Provider Demographics
NPI:1205428265
Name:BEROSIK, JULIE ANN (MFT IT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:BEROSIK
Suffix:
Gender:F
Credentials:MFT IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W 1ST ST # ST270
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-1742
Mailing Address - Country:US
Mailing Address - Phone:715-246-4840
Mailing Address - Fax:715-254-9459
Practice Address - Street 1:150 W 1ST ST # ST270
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-1742
Practice Address - Country:US
Practice Address - Phone:715-246-4840
Practice Address - Fax:715-254-9459
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI766-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist