Basic Information
| Provider Information | |||||||||
| NPI: | 1417665357 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELAFIELD | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | KENDALL | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LPC, LMFT ASSOCIATE | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LAW | ||||||||
| OtherFirstName: | JULIE | ||||||||
| OtherMiddleName: | KENDALL | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6021 BRIDGECREEK WAY | ||||||||
| Address2: | |||||||||
| City: | WESTWORTH VILLAGE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761143538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124136322 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1701 RIVER RUN STE 1118 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761076557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722217900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2022 | ||||||||
| LastUpdateDate: | 11/09/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 81910 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.