MEDICARE: JULIE TIERNEY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1154924819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JULIE TIERNEY LLC

Provider Business Mailing Address
First Line	:	1622 W COLUMBIA AVE APT 3N
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-4160
Country	:	US
Telephone Number	:	415-420-8612
Fax Number	:

Provider Business Practice Location Address
First Line	:	1622 W COLUMBIA AVE APT 3N
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-4160
Country	:	US
Telephone Number	:	415-420-8612
Fax Number	:

Authorized Official
Title or Position	:	MARRIAGE AND FAMILY THERAPIST
Name	:	JULIA TIERNEY
Credential	:
Telephone Number	:	415-420-8612

Provider Enumeration Date	:	11/17/2020
Last Update Date	:	12/03/2020

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