Provider Demographics
NPI:1831328913
Name:HENZEL, JULIE NICOLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:NICOLE
Last Name:HENZEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5174 BLAZER PKWY
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1339
Mailing Address - Country:US
Mailing Address - Phone:614-792-9104
Mailing Address - Fax:614-792-2392
Practice Address - Street 1:5174 BLAZER PKWY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1339
Practice Address - Country:US
Practice Address - Phone:614-792-9104
Practice Address - Fax:614-792-2392
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6835103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist