Healthcare Provider Details

I. General information

NPI: 1104889450
Provider Name (Legal Business Name): JULIE STATES PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 W FOSTER AVE
STATE COLLEGE PA
16801-4823
US

IV. Provider business mailing address

229 W FOSTER AVE
STATE COLLEGE PA
16801-4823
US

V. Phone/Fax

Practice location:
  • Phone: 814-238-1880
  • Fax: 814-867-2794
Mailing address:
  • Phone: 814-238-1880
  • Fax: 814-867-2794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS015297
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: