Basic Information
Provider Information
NPI: 1003140740
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: YORK
FirstName: JULIE
MiddleName: KRISTEN RANDALL
NamePrefix:  
NameSuffix:  
Credential: M.ED., LCPC-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: RANDALL
OtherFirstName: JULIE
OtherMiddleName: KRISTEN
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 167 SCHOOL ST
Address2:  
City: PITTSFIELD
State: ME
PostalCode: 049674747
CountryCode: US
TelephoneNumber: 2072996052
FaxNumber:  
Practice Location
Address1: 167 SCHOOL ST
Address2:  
City: PITTSFIELD
State: ME
PostalCode: 049674747
CountryCode: US
TelephoneNumber: 2072996052
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/29/2009
LastUpdateDate: 07/29/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XXL3579MEY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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