Provider Demographics
NPI:1548378185
Name:MYERS, JULIE ELIZABETH (LICSW)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ELIZABETH
Last Name:MYERS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:D
Other - Last Name:DINSMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2111 N NORTHGATE WAY
Mailing Address - Street 2:SUITE 217
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9018
Mailing Address - Country:US
Mailing Address - Phone:206-363-8194
Mailing Address - Fax:206-257-0488
Practice Address - Street 1:2111 N NORTHGATE WAY
Practice Address - Street 2:SUITE 217
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9018
Practice Address - Country:US
Practice Address - Phone:206-363-8194
Practice Address - Fax:206-257-0488
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000050581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA446098001OtherGROUP HEALTH
WADI0119OtherREGENCE BLUE SHIELD
WA446098001OtherGROUP HEALTH