Healthcare Provider Details

I. General information

NPI: 1912491069
Provider Name (Legal Business Name): JULIA GRACE FISHER ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIA WIBLE

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6180 VANDERBILT AVE
DALLAS TX
75214-3332
US

IV. Provider business mailing address

6180 VANDERBILT AVE
DALLAS TX
75214-3332
US

V. Phone/Fax

Practice location:
  • Phone: 562-896-8673
  • Fax:
Mailing address:
  • Phone: 562-896-8673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number17-264
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC011302
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: