Provider Demographics
NPI:1740952357
Name:HENDRIX, JULIE (PLPC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 BROWN DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGEVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63873-1015
Mailing Address - Country:US
Mailing Address - Phone:417-234-0754
Mailing Address - Fax:
Practice Address - Street 1:1804 HERIFORD RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-1942
Practice Address - Country:US
Practice Address - Phone:417-234-0754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021035033101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1346671690Medicaid