Provider Demographics
NPI:1801064811
Name:AYALA, JULIE ANN (LPC)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANN
Last Name:AYALA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:TRUMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:4880 EDGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-7767
Mailing Address - Country:US
Mailing Address - Phone:409-893-1377
Mailing Address - Fax:
Practice Address - Street 1:4880 EDGEWOOD LN
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-7767
Practice Address - Country:US
Practice Address - Phone:409-893-1377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15512101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX028574401Medicaid