Provider Demographics
NPI:1801279807
Name:BIRNER, JULIE (MS, LCSWPIP,QMHP,LAC)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:BIRNER
Suffix:
Gender:F
Credentials:MS, LCSWPIP,QMHP,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 HAINES AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-0710
Mailing Address - Country:US
Mailing Address - Phone:605-716-7841
Mailing Address - Fax:605-718-0404
Practice Address - Street 1:1520 HAINES AVE STE 6
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-0710
Practice Address - Country:US
Practice Address - Phone:605-716-7841
Practice Address - Fax:605-718-0404
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 103TA0400X
SD6602104100000X
SD9703943103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker