Provider Demographics
NPI:1174097422
Name:DRAVIS, JULIE LYNETTE (LPC, MAC, CDCI)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:LYNETTE
Last Name:DRAVIS
Suffix:
Gender:F
Credentials:LPC, MAC, CDCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 903
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-0903
Mailing Address - Country:US
Mailing Address - Phone:907-252-6728
Mailing Address - Fax:
Practice Address - Street 1:508 S WILLOW ST STE D
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-6940
Practice Address - Country:US
Practice Address - Phone:907-252-6728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK491101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional