Healthcare Provider Details

I. General information

NPI: 1629389655
Provider Name (Legal Business Name): JULIE ANNE ST. CLAIR LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE ANNE ZSCHOCHE LPC

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 10/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2564 NE COURTNEY DR
BEND OR
97701-7638
US

IV. Provider business mailing address

2564 NE COURTNEY DR
BEND OR
97701-7638
US

V. Phone/Fax

Practice location:
  • Phone: 541-678-5277
  • Fax: 541-678-5280
Mailing address:
  • Phone: 541-678-5277
  • Fax: 541-678-5280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC-1416
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier500674852
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: