Healthcare Provider Details

I. General information

NPI: 1326505413
Provider Name (Legal Business Name): JULIE D LUNG BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4609 GRAPE RD STE D1B
MISHAWAKA IN
46545-8259
US

IV. Provider business mailing address

5776 GRAPE RD PMB 171
MISHAWAKA IN
46545
US

V. Phone/Fax

Practice location:
  • Phone: 574-217-1624
  • Fax:
Mailing address:
  • Phone: 574-217-1624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-79779
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-29218
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: