=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790924165
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIE ANN BARBOUR M.S., LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2009
-----------------------------------------------------
Last Update Date | 02/09/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2017 CAMINO CENTROLOMA
-----------------------------------------------------
City | FULLERTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92833-1835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-615-4055
-----------------------------------------------------
Fax | 714-738-5620
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2017 CAMINO CENTROLOMA
-----------------------------------------------------
City | FULLERTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92833-1835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-615-4055
-----------------------------------------------------
Fax | 714-738-5620
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFC 41212
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------