Provider Demographics
NPI:1740514447
Name:RICHARDSON, JULIE ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 WILDROSE LN
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-3482
Mailing Address - Country:US
Mailing Address - Phone:970-901-1435
Mailing Address - Fax:
Practice Address - Street 1:114 N BOULEVARD ST
Practice Address - Street 2:#208
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-3000
Practice Address - Country:US
Practice Address - Phone:970-641-5160
Practice Address - Fax:970-641-5160
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-28
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO992776104100000X, 1041C0700X
MN19481104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker