MEDICARE: JULIA CORE LP

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	103TC0700X	Clinical Psychologist	PSY0005614	CO
2	390200000X	Student in an Organized Health Care Education/Training Program
3	103TC0700X	Clinical Psychologist	PSY1401	OK

General Provider Information

NPI Number	:	1548785819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA CORE LP

Provider Business Mailing Address
First Line	:	2417 E 53RD ST STE 101
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-6600
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2417 E 53RD ST STE 101
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-6600
Country	:	US
Telephone Number	:	281-606-5553
Fax Number	:

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

Provider Enumeration Date	:	08/08/2017
Last Update Date	:	01/07/2025

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Directions to “ JULIA CORE LP” Practice Location

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