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NPI Code Detail

MEDICARE: MISS JULIA ELIZABETH DAVICK MA

MEDICARE: MISS JULIA ELIZABETH DAVICK MA
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 Therapist
2101YP2500XProfessional CounselorCC02139MN

General Provider Information

NPI Number : 1780956268
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS JULIA ELIZABETH DAVICK MA
Provider Business Mailing Address
First Line : PO BOX 367
Second Line :
City : LITTLE FALLS
State : MN
Zip : 56345-0367
Country : US
Telephone Number : 320-632-6647
Fax Number : 320-639-0014
Provider Business Practice Location Address
First Line : 823 MAPLE ST
Second Line :
City : BRAINERD
State : MN
Zip : 56401-3770
Country : US
Telephone Number : 815-978-6514
Fax Number : 218-454-1024
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2012
Last Update Date : 10/30/2019

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