Healthcare Provider Details

I. General information

NPI: 1710128343
Provider Name (Legal Business Name): JULIE ANNETTE PREWITT LBSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2009
Last Update Date: 03/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 W. LAMAR ST.
JASPER TX
75951-4014
US

IV. Provider business mailing address

139 W. LAMAR ST.
JASPER TX
75951-4014
US

V. Phone/Fax

Practice location:
  • Phone: 409-384-6829
  • Fax: 409-384-4770
Mailing address:
  • Phone: 409-384-6829
  • Fax: 409-384-4770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number52483
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: