Healthcare Provider Details

I. General information

NPI: 1710623566
Provider Name (Legal Business Name): JULIA MEFFERD LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 CHURCH ST
EVANSTON IL
60201-3875
US

IV. Provider business mailing address

1016 N OAKLEY BLVD
CHICAGO IL
60622-3560
US

V. Phone/Fax

Practice location:
  • Phone: 847-612-0149
  • Fax:
Mailing address:
  • Phone: 847-612-0149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number166001456
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: