Provider Demographics
NPI:1740296524
Name:GANLEY, JULIE A
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:A
Last Name:GANLEY
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 1:7026 CORPORATE WAY
Mailing Address - Street 2:100
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4240
Mailing Address - Country:US
Mailing Address - Phone:937-436-9212
Mailing Address - Fax:
Practice Address - Street 1:7026 CORPORATE WAY
Practice Address - Street 2:100
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4240
Practice Address - Country:US
Practice Address - Phone:937-436-9212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4283103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist