Provider Demographics
NPI:1396983011
Name:DOHERTY, JULIE ANN (LCPC)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANN
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 LEAMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2061
Mailing Address - Country:US
Mailing Address - Phone:847-987-3419
Mailing Address - Fax:
Practice Address - Street 1:1834-36 GLENVIEW RD., 2ND FL
Practice Address - Street 2:ANTALEE SPA & WELLNESS CENTER
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025
Practice Address - Country:US
Practice Address - Phone:847-987-3419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007095101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional