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General NPI Number Information
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NPI Number | 1235684739
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Entity Type | Organization
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Legal Business Name | JULIE MELLOW COUNSELING
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Dates
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Enumeration Date | 08/25/2016
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Last Update Date | 08/25/2016
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Provider Practice Location Address
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Address Line | 979 TUCKER RD
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City | HOOD RIVER
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State | OR
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Zip | 97031-9591
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Country | US
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Telephone | 541-490-2999
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Fax | 541-386-6834
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Provider Business Mailing Address
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Address Line | 3372 BRADLEY DR
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City | HOOD RIVER
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State | OR
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Zip | 97031-9614
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Country | US
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Telephone | 541-490-2999
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JULIE CATHERINE MELLOW
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Credential | LPC, LMHC
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Telephone | 541-490-2999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | C4134
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | LH60626167
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | C4134
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | LH 60626167
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License Number State | WA
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