1568788370 NPI number — JULIANNE STROUP LCSW

Table of content: JULIANNE STROUP LCSW (NPI 1568788370)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568788370 NPI number — JULIANNE STROUP LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STROUP
Provider First Name:
JULIANNE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WARRINGTON
Provider Other First Name:
JULIANNE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568788370
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1468
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELEPHANT BUTTE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87935-1468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-497-0352
Provider Business Mailing Address Fax Number:
575-548-7290

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 NM HWY 195
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
ELEPHANT BUTTE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87935-1468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-497-0352
Provider Business Practice Location Address Fax Number:
575-548-7290
Provider Enumeration Date:
04/19/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  C-06711 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 28480805 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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