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General NPI Number Information
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NPI Number | 1295875136
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Entity Type | Individual
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Provider Name | JULIE MARIE MATIJA L.C.P.C.
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Gender | Female
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 07/22/2019
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Provider Practice Location Address
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Address Line | 155 N MICHIGAN AVE STE 325-326
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City | CHICAGO
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State | IL
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Zip | 60601-7511
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Country | US
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Telephone | 847-942-2006
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Fax | 312-239-6000
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Provider Business Mailing Address
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Address Line | 1926 KEENEY ST
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City | EVANSTON
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State | IL
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Zip | 60202-1938
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Country | US
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Telephone | 847-440-4312
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180005665
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License Number State | IL
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