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General NPI Number Information
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NPI Number | 1619170289
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Entity Type | Individual
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Provider Name | JULIE THERESE PEARCE M.F.T.
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Gender | Female
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Dates
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Enumeration Date | 06/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 21711 EVENINGSIDE LN
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City | LAKE FOREST
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State | CA
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Zip | 92630-2404
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Country | US
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Telephone | 949-830-8777
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Fax | 949-770-2072
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Provider Business Mailing Address
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Address Line | 21711 EVENINGSIDE LN
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City | LAKE FOREST
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State | CA
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Zip | 92630-2404
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Country | US
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Telephone | 949-830-8777
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Fax | 949-770-2072
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT20624
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License Number State | CA
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