Healthcare Provider Details

I. General information

NPI: 1245336163
Provider Name (Legal Business Name): JULIE B BARBOUR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. JULIE MELLMAN

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 S KYRENE RD STE 4
CHANDLER AZ
85226-4687
US

IV. Provider business mailing address

90 S KYRENE RD STE 4
CHANDLER AZ
85226-4687
US

V. Phone/Fax

Practice location:
  • Phone: 602-697-7584
  • Fax: 480-775-6425
Mailing address:
  • Phone: 602-697-7584
  • Fax: 480-775-6425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC005276
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-16549
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6106544
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 2
IdentifierC005276
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerSOCIAL WORKERS LICENSE
# 3
IdentifierLCSW-16549
Identifier TypeOTHER
Identifier StateAZ
Identifier IssuerSOCIAL WORK LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: