Provider Demographics
NPI:1902948102
Name:ODDONE, JULIE (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:ODDONE
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 E ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4649
Mailing Address - Country:US
Mailing Address - Phone:415-361-2877
Mailing Address - Fax:
Practice Address - Street 1:132 E STREET
Practice Address - Street 2:SUITE 320
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4217
Practice Address - Country:US
Practice Address - Phone:415-361-2877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC48515106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7260OtherMEDICAL