Provider Demographics
NPI:1912770413
Name:BLEAK, JULIE ANN (LMFT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:BLEAK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1173 S 250 W STE 208
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-6747
Mailing Address - Country:US
Mailing Address - Phone:435-688-1111
Mailing Address - Fax:
Practice Address - Street 1:640 E 700 S STE 205B
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5773
Practice Address - Country:US
Practice Address - Phone:435-688-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist