Healthcare Provider Details

I. General information

NPI: 1982940771
Provider Name (Legal Business Name): FERN JULY LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2012
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 COOLIDGE AVE
OAKLAND CA
94602-3311
US

IV. Provider business mailing address

PO BOX 15413
SACRAMENTO CA
95851-0413
US

V. Phone/Fax

Practice location:
  • Phone: 406-544-1089
  • Fax:
Mailing address:
  • Phone: 406-544-1089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number92100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: