Healthcare Provider Details

I. General information

NPI: 1184538480
Provider Name (Legal Business Name): JULIA MYA PRESTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14813 W 101ST AVE
DYER IN
46311-3027
US

IV. Provider business mailing address

155 S FLOYD LN
CHICAGO HEIGHTS IL
60411-1109
US

V. Phone/Fax

Practice location:
  • Phone: 219-245-7970
  • Fax:
Mailing address:
  • Phone: 219-245-7970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: