Provider Demographics
NPI:1255378006
Name:LYELL, JULIANNA M (PSYD)
Entity type:Individual
Prefix:DR
First Name:JULIANNA
Middle Name:M
Last Name:LYELL
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 1:5175 E PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 304
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3317
Mailing Address - Country:US
Mailing Address - Phone:562-221-4141
Mailing Address - Fax:
Practice Address - Street 1:5175 E PACIFIC COAST HWY
Practice Address - Street 2:SUITE 304
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3317
Practice Address - Country:US
Practice Address - Phone:562-221-4141
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19160103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4141-01OtherCOMPSYCH PROVIDER NUMBER
CA0007273525OtherAETNA PIN
CA57227414190804A001OtherTRICARE/TRIWEST PROVIDER