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General NPI Number Information
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NPI Number | 1043079940
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Entity Type | Individual
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Provider Name | JULIA RENAE PRICE
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Gender | Female
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Dates
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Enumeration Date | 03/14/2024
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Last Update Date | 03/14/2024
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Provider Practice Location Address
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Address Line | 1110 WILKINSON TRCE STE 103
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City | BOWLING GREEN
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State | KY
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Zip | 42103-3402
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Country | US
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Telephone | 248-227-0232
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Fax |
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Provider Business Mailing Address
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Address Line | 1274 ADAMS ST
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City | BOWLING GREEN
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State | KY
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Zip | 42101-3413
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Country | US
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Telephone | 270-528-6603
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 287793
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License Number State | KY
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