Provider Demographics
NPI:1912077397
Name:FANT, JULIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:FANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:JULIANN
Other - Middle Name:
Other - Last Name:FANT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1926 MAYAPPLE DR
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-2598
Mailing Address - Country:US
Mailing Address - Phone:501-847-8203
Mailing Address - Fax:
Practice Address - Street 1:209 ROYA LN
Practice Address - Street 2:STE 4
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-2669
Practice Address - Country:US
Practice Address - Phone:501-213-1077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical