Healthcare Provider Details

I. General information

NPI: 1568788370
Provider Name (Legal Business Name): JULIANNE STROUP LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIANNE WARRINGTON LCSW

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NM HWY 195 STE A
ELEPHANT BUTTE NM
87935-1468
US

IV. Provider business mailing address

PO BOX 1468
ELEPHANT BUTTE NM
87935-1468
US

V. Phone/Fax

Practice location:
  • Phone: 575-497-0352
  • Fax: 575-548-7290
Mailing address:
  • Phone: 575-497-0352
  • Fax: 575-548-7290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-06711
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: