Provider Demographics
NPI:1356695878
Name:PRINDLE, JULIE ECONVY (PHD, LCSW)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ECONVY
Last Name:PRINDLE
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 NW 21ST AVE STE B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1449
Mailing Address - Country:US
Mailing Address - Phone:503-975-4898
Mailing Address - Fax:503-233-8905
Practice Address - Street 1:820 NW 21ST AVE STE B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1449
Practice Address - Country:US
Practice Address - Phone:503-975-4898
Practice Address - Fax:503-233-8905
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL40361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical