Provider Demographics
NPI:1265998926
Name:DAUTH, JULIE ELIZABETH
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ELIZABETH
Last Name:DAUTH
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 1:1646 LAPLAND RD
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05492-9768
Mailing Address - Country:US
Mailing Address - Phone:802-644-5147
Mailing Address - Fax:
Practice Address - Street 1:56 OLD FARM RD
Practice Address - Street 2:
Practice Address - City:STOWE
Practice Address - State:VT
Practice Address - Zip Code:05672-4434
Practice Address - Country:US
Practice Address - Phone:802-585-0071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101YM0800X
VT097.0134167101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT097.0134167OtherSTATE OF VERMONT ALLIED MENTAL HEALTH PRACTIONERS