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General NPI Number Information
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NPI Number | 1932293693
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Entity Type | Individual
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Provider Name | JULIE C ETZEL PHD
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Gender | Female
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 06/21/2011
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Provider Practice Location Address
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Address Line | 1169 EASTERN PKWY SUITE 3357
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City | LOUISVILLE
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State | KY
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Zip | 40217-1417
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Country | US
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Telephone | 502-454-0755
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Fax | 502-479-1231
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Provider Business Mailing Address
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Address Line | 1169 EASTERN PKWY SUITE 2266
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City | LOUISVILLE
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State | KY
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Zip | 40217-1417
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Country | US
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Telephone | 502-238-3178
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Fax | 502-238-3653
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1616
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License Number State | KY
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