Healthcare Provider Details

I. General information

NPI: 1598886962
Provider Name (Legal Business Name): JULIE D SAXON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 30TH AVE SUITE 202
GULFPORT MS
39501-1818
US

IV. Provider business mailing address

1105 30TH AVE SUITE 202
GULFPORT MS
39501-1818
US

V. Phone/Fax

Practice location:
  • Phone: 228-863-7358
  • Fax: 228-863-9325
Mailing address:
  • Phone: 228-863-7358
  • Fax: 228-863-9325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC1000
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: