Provider Demographics
NPI:1740453802
Name:WATERS, JULIE ELIZABETH (EDD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ELIZABETH
Last Name:WATERS
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 WURZBACH RD
Mailing Address - Street 2:STE. 1204
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-4330
Mailing Address - Country:US
Mailing Address - Phone:210-857-1190
Mailing Address - Fax:
Practice Address - Street 1:8600 WURZBACH RD
Practice Address - Street 2:STE. 1204
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-4330
Practice Address - Country:US
Practice Address - Phone:210-857-1190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30899103T00000X, 103TF0000X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth