Healthcare Provider Details

I. General information

NPI: 1245672641
Provider Name (Legal Business Name): JULIE HOLBROOK AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1258 W SOUTH JORDAN PKWY
SOUTH JORDAN UT
84095-4711
US

IV. Provider business mailing address

1258 W SOUTH JORDAN PKWY
SOUTH JORDAN UT
84095-4711
US

V. Phone/Fax

Practice location:
  • Phone: 801-255-1155
  • Fax:
Mailing address:
  • Phone: 801-255-1155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number8661487-3904
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: