Provider Demographics
NPI:1265160741
Name:RUSSO, JULIA ANTOINETTE (MA, LPC)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:ANTOINETTE
Last Name:RUSSO
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 S COLORADO BLVD STE A302
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-3315
Mailing Address - Country:US
Mailing Address - Phone:631-204-7278
Mailing Address - Fax:
Practice Address - Street 1:1385 S COLORADO BLVD STE A302
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-3315
Practice Address - Country:US
Practice Address - Phone:631-204-7278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0020384101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health