Healthcare Provider Details

I. General information

NPI: 1508586637
Provider Name (Legal Business Name): JULIANNE CARMONA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 N ST
MERCED CA
95340-4657
US

IV. Provider business mailing address

632 W 13TH ST
MERCED CA
95341-5908
US

V. Phone/Fax

Practice location:
  • Phone: 209-381-4550
  • Fax:
Mailing address:
  • Phone: 209-381-4056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number164650
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: