Provider Demographics
NPI:1841034170
Name:WILSON, JULIE (LPCC)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 HUNTINGTON DR STE 408
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-5460
Mailing Address - Country:US
Mailing Address - Phone:323-345-1402
Mailing Address - Fax:888-529-9787
Practice Address - Street 1:1499 HUNTINGTON DR STE 408
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-5460
Practice Address - Country:US
Practice Address - Phone:323-345-1402
Practice Address - Fax:888-529-9787
Is Sole Proprietor?:No
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC16012101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health