Provider Demographics
NPI:1932632932
Name:LAFOLLETTE, JULIE RENEE (PHD, HSPP)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:RENEE
Last Name:LAFOLLETTE
Suffix:
Gender:F
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 E HAGAN ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-8557
Mailing Address - Country:US
Mailing Address - Phone:812-650-1234
Mailing Address - Fax:812-650-1235
Practice Address - Street 1:3901 E HAGAN ST
Practice Address - Street 2:SUITE F
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-8557
Practice Address - Country:US
Practice Address - Phone:812-650-1234
Practice Address - Fax:812-650-1235
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20043032A103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling