Basic Information
| Provider Information | |||||||||
| NPI: | 1801218128 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1122 NE 13TH STREET | ||||||||
| Address2: | ORB 1200 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052718133 | ||||||||
| FaxNumber: | 4052713887 | ||||||||
| Practice Location | |||||||||
| Address1: | 1122 NE 13TH ST | ||||||||
| Address2: | ORB 1200 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731171039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052718133 | ||||||||
| FaxNumber: | 4052713887 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2014 | ||||||||
| LastUpdateDate: | 01/07/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 1194 | OK | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.