=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942164405
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIA BALDERAS LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2025
-----------------------------------------------------
Last Update Date | 12/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8080 E CENTRAL AVE STE 230
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67206-2369
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-518-7734
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2023 N. BROADMOOR AVE APT. 429
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-518-7734
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 05097
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------