Provider Demographics
NPI:1649785544
Name:MENANNO, JULIE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:MENANNO
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 1:215 PAINTED HILLS RD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8070
Mailing Address - Country:US
Mailing Address - Phone:818-456-9012
Mailing Address - Fax:
Practice Address - Street 1:321 E MAIN ST STE 418
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-4702
Practice Address - Country:US
Practice Address - Phone:818-456-9012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT27109101YP2500X
MT22758106H00000X
CA93696106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist