MEDICARE: JULIE ANN ELMENHURST LICSW

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	106H00000X	Marriage & Family Therapist	LW 00009297	WA

General Provider Information

NPI Number	:	1679712046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE ANN ELMENHURST LICSW

Provider Business Mailing Address
First Line	:	1030 N CENTER PKWY
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99336-7160
Country	:	US
Telephone Number	:	509-492-7400
Fax Number	:	509-783-7539

Provider Business Practice Location Address
First Line	:	1030 N CENTER PKWY
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99336-7160
Country	:	US
Telephone Number	:	509-492-7400
Fax Number	:	509-783-7539

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

Provider Enumeration Date	:	02/09/2009
Last Update Date	:	02/09/2009

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