Provider Demographics
NPI:1982956389
Name:VANDENBERGHE, JULIE LYNN (CMHC)
Entity Type:Individual
Prefix:MISS
First Name:JULIE
Middle Name:LYNN
Last Name:VANDENBERGHE
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 W 1875 S APT B207
Mailing Address - Street 2:
Mailing Address - City:WOODS CROSS
Mailing Address - State:UT
Mailing Address - Zip Code:84010-4114
Mailing Address - Country:US
Mailing Address - Phone:310-357-1746
Mailing Address - Fax:
Practice Address - Street 1:467 W 1875 S APT B207
Practice Address - Street 2:
Practice Address - City:WOODS CROSS
Practice Address - State:UT
Practice Address - Zip Code:84010-4114
Practice Address - Country:US
Practice Address - Phone:310-357-1746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8433523-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health