MEDICARE: JULIE PREVOZNIK LPC

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	101YM0800X	Mental Health Counselor	LPC 0546	AZ

General Provider Information

NPI Number	:	1275607301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE PREVOZNIK LPC

Provider Business Mailing Address
First Line	:	3811 W SURREY AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-1155
Country	:	US
Telephone Number	:	602-439-1078
Fax Number	:	602-993-6455

Provider Business Practice Location Address
First Line	:	11225 N 28TH DR
Second Line	:	SUITE D215
City	:	PHOENIX
State	:	AZ
Zip	:	85029-5606
Country	:	US
Telephone Number	:	602-993-6077
Fax Number	:	602-993-6455

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	07/08/2007

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