Provider Demographics
NPI:1861728826
Name:MASTIN, JULIE R (LPC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:R
Last Name:MASTIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-4520
Mailing Address - Country:US
Mailing Address - Phone:817-624-9910
Mailing Address - Fax:817-624-9910
Practice Address - Street 1:1009 HENDERSON ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-4520
Practice Address - Country:US
Practice Address - Phone:817-624-9910
Practice Address - Fax:817-624-9910
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62849101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional