MEDICARE: JULIA S MONCRIEF M.ED, CHW, RA

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	C.2102995-TRNE	OH
2	171M00000X	Case Manager/Care Coordinator
3	390200000X	Student in an Organized Health Care Education/Training Program
4	172V00000X	Community Health Worker	CHW.002386	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568058030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA S MONCRIEF M.ED, CHW, RA

Provider Business Mailing Address
First Line	:	9 CHESAPEAKE PLZ
Second Line	:
City	:	CHESAPEAKE
State	:	OH
Zip	:	45619-1003
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	31500 CHIEFTAIN DR
Second Line	:
City	:	LOGAN
State	:	OH
Zip	:	43138-8421
Country	:	US
Telephone Number	:	740-270-3286
Fax Number	:

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

Provider Enumeration Date	:	12/17/2020
Last Update Date	:	10/21/2024

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