Healthcare Provider Details

I. General information

NPI: 1003166158
Provider Name (Legal Business Name): JULIE ANN PERDUE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5590 CREEK DALE WAY
BUFORD GA
30518-4414
US

IV. Provider business mailing address

5590 CREEK DALE WAY
BUFORD GA
30518-4414
US

V. Phone/Fax

Practice location:
  • Phone: 405-837-6272
  • Fax:
Mailing address:
  • Phone: 405-837-6272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number78349
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number012984
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: