Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PS015297 | PA |
NPI | 1104889450 |
---|---|
Provider Name | Dr. Julie States |
First Address | State College, PA 16801-4823 |
Second Address | State College, PA 16801-4823 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2006 |
Last Update Date | 08/07/2007 |