MEDICARE: MRS. JULIE HARPER PSY-D

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	PY7168	FL

General Provider Information

NPI Number	:	1558335570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIE HARPER PSY-D

Provider Business Mailing Address
First Line	:	519 BOULDER ST
Second Line	:
City	:	CRESTVIEW
State	:	FL
Zip	:	32536-2251
Country	:	US
Telephone Number	:	850-226-7322
Fax Number	:	850-226-7491

Provider Business Practice Location Address
First Line	:	151 MARY ESTHER BLVD
Second Line	:	STE 308A
City	:	MARY ESTHER
State	:	FL
Zip	:	32569-1972
Country	:	US
Telephone Number	:	850-226-7322
Fax Number	:	850-226-7491

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	10/23/2015

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