Provider Demographics
NPI:1811452980
Name:TEWELL, JULIE ARYN (MED, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ARYN
Last Name:TEWELL
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-4319
Mailing Address - Country:US
Mailing Address - Phone:502-777-2397
Mailing Address - Fax:
Practice Address - Street 1:907 LYNDON LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-3815
Practice Address - Country:US
Practice Address - Phone:502-777-2397
Practice Address - Fax:502-808-6024
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3538103K00000X
KY272717103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYKY-7100771270Medicaid