MEDICARE: JULIANDRA DEAR LPC

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	101YP2500X	Professional Counselor	67389	TX

General Provider Information

NPI Number	:	1821417759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIANDRA DEAR LPC

Provider Business Mailing Address
First Line	:	409 N PEARSON ST
Second Line	:
City	:	GODLEY
State	:	TX
Zip	:	76044-3748
Country	:	US
Telephone Number	:	817-389-2121
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 N PEARSON ST
Second Line	:
City	:	GODLEY
State	:	TX
Zip	:	76044-3748
Country	:	US
Telephone Number	:	817-389-2121
Fax Number	:

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

Provider Enumeration Date	:	04/08/2014
Last Update Date	:	01/08/2016

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Directions to “ JULIANDRA DEAR LPC” Practice Location

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