Provider Demographics
NPI:1912413972
Name:THRALL, JULIANA ANGELINE (LPCC, ATR-BC)
Entity Type:Individual
Prefix:
First Name:JULIANA
Middle Name:ANGELINE
Last Name:THRALL
Suffix:
Gender:F
Credentials:LPCC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 4TH ST E STE 301
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-1771
Mailing Address - Country:US
Mailing Address - Phone:651-318-0109
Mailing Address - Fax:651-344-0515
Practice Address - Street 1:275 4TH ST E STE 301
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-1771
Practice Address - Country:US
Practice Address - Phone:651-318-0109
Practice Address - Fax:651-344-0515
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
16-076221700000X
MN1706101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Multi-Specialty