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NPI Code Detail

MEDICARE: JULIE PERRON LMFTA

MEDICARE: JULIE PERRON LMFTA
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
1106H00000XMarriage & Family Therapist85000275AIN

General Provider Information

NPI Number : 1740633239
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE PERRON LMFTA
Provider Business Mailing Address
First Line : 105 E JEFFERSON BLVD
Second Line : STE 310
City : SOUTH BEND
State : IN
Zip : 46601-1922
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 105 E JEFFERSON BLVD
Second Line : STE 310
City : SOUTH BEND
State : IN
Zip : 46601-1922
Country : US
Telephone Number : 574-383-5859
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2016
Last Update Date : 07/19/2016

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