Provider Demographics
NPI:1881128262
Name:MACKEL, JULIE MARIE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:MACKEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:MARIE
Other - Last Name:STANLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:403 KINGSBARN CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NV
Mailing Address - Zip Code:89403-8781
Mailing Address - Country:US
Mailing Address - Phone:775-230-8695
Mailing Address - Fax:
Practice Address - Street 1:403 KINGSBARN CT
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NV
Practice Address - Zip Code:89403-8781
Practice Address - Country:US
Practice Address - Phone:775-230-8695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV61605103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV61605OtherSCHOOL PSYCHOLOGIST LICENSE