Healthcare Provider Details

I. General information

NPI: 1124045190
Provider Name (Legal Business Name): JULIA K NIVER MS, CADC III
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIA K HALLORAN MS

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 EASTERN AVE
PLYMOUTH WI
53073-4281
US

IV. Provider business mailing address

2209 EASTERN AVE
PLYMOUTH WI
53073-4281
US

V. Phone/Fax

Practice location:
  • Phone: 920-892-7606
  • Fax: 920-449-4247
Mailing address:
  • Phone: 920-892-7606
  • Fax: 920-449-4247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2322
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3459-125
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: