Basic Information
| Provider Information | |||||||||
| NPI: | 1700820644 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADAMS | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | KAREN | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 914 164TH ST SE | ||||||||
| Address2: | # 318 | ||||||||
| City: | MILL CREEK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980126385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253795065 | ||||||||
| FaxNumber: | 4253790548 | ||||||||
| Practice Location | |||||||||
| Address1: | 543 MAIN ST | ||||||||
| Address2: | STE 104 | ||||||||
| City: | EDMONDS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980203162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4255131600 | ||||||||
| FaxNumber: | 2069150141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 08/03/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PY00001981 | WA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 7117781 | 05 | WA | MEDICAID |