Provider Demographics
NPI:1538413042
Name:BERRY, JULIE C (MFT)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:C
Last Name:BERRY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5344 CIRCLE DR APT 37
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-5647
Mailing Address - Country:US
Mailing Address - Phone:818-207-0171
Mailing Address - Fax:
Practice Address - Street 1:16633 VENTURA BLVD SUITE 1008
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1856
Practice Address - Country:US
Practice Address - Phone:818-995-0368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 50869106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist