Provider Demographics
NPI:1700156437
Name:CHAN BOON, JULIE JEANETTE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:JEANETTE
Last Name:CHAN BOON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:JEANETTE
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:8783 S REDWOOD RD STE B
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-5640
Mailing Address - Country:US
Mailing Address - Phone:385-276-7825
Mailing Address - Fax:385-360-1698
Practice Address - Street 1:8783 S REDWOOD RD STE B
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5640
Practice Address - Country:US
Practice Address - Phone:385-276-7825
Practice Address - Fax:385-360-1698
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11008471-3501101YM0800X
IDLCSW-36059101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health