MEDICARE: JULIE P BIRKY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1083933295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE P BIRKY

Provider Business Mailing Address
First Line	:	2612 W JOHN ST
Second Line	:
City	:	CHAMPAIGN
State	:	IL
Zip	:	61821-3517
Country	:	US
Telephone Number	:	815-483-5345
Fax Number	:

Provider Business Practice Location Address
First Line	:	3115 VILLAGE OFFICE PL
Second Line	:
City	:	CHAMPAIGN
State	:	IL
Zip	:	61822-7673
Country	:	US
Telephone Number	:	815-483-5345
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2010
Last Update Date	:	05/12/2022

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Directions to “ JULIE P BIRKY ” Practice Location

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