Provider Demographics
NPI:1295577617
Name:GOTSCH, JULIE ANN (CMHC- MS, LPC-IT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:GOTSCH
Suffix:
Gender:F
Credentials:CMHC- MS, LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:UNION GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53182-1047
Mailing Address - Country:US
Mailing Address - Phone:262-864-5045
Mailing Address - Fax:
Practice Address - Street 1:826 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:UNION GROVE
Practice Address - State:WI
Practice Address - Zip Code:53182-1047
Practice Address - Country:US
Practice Address - Phone:262-864-5045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7895-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health