Healthcare Provider Details

I. General information

NPI: 1740192210
Provider Name (Legal Business Name): JULIE BAGLEY LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2142 W RAILROAD AVE
SHELTON WA
98584-7813
US

IV. Provider business mailing address

1417 EVERGREEN PARK DR SW UNIT 104
OLYMPIA WA
98502-5838
US

V. Phone/Fax

Practice location:
  • Phone: 360-489-5091
  • Fax:
Mailing address:
  • Phone: 360-590-1941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHCA.MC.70178059
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: