Provider Demographics
NPI:1255172094
Name:VARELA, JULISSA LISSET (CIT, MS, MBA)
Entity type:Individual
Prefix:
First Name:JULISSA
Middle Name:LISSET
Last Name:VARELA
Suffix:
Gender:F
Credentials:CIT, MS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 EARHART BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125-1955
Mailing Address - Country:US
Mailing Address - Phone:504-380-4649
Mailing Address - Fax:504-821-7296
Practice Address - Street 1:4150 EARHART BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-1955
Practice Address - Country:US
Practice Address - Phone:504-821-7120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5747101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor