MEDICARE: JULIA MARIE-BANNEROT HOUGH LCSW

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	1041C0700X	Clinical Social Worker	CSW.09931468	CO

General Provider Information

NPI Number	:	1326843392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA MARIE-BANNEROT HOUGH LCSW

Provider Business Mailing Address
First Line	:	9362 GRAND CORDERA PKWY STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924-7007
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9362 GRAND CORDERA PKWY STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924-7007
Country	:	US
Telephone Number	:	719-416-4335
Fax Number	:	719-960-3227

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

Provider Enumeration Date	:	02/14/2025
Last Update Date	:	02/19/2025

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