Provider Demographics
NPI:1366746638
Name:HAGGERTY, JULIE ANN (CPCI)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:HAGGERTY
Suffix:
Gender:F
Credentials:CPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 S 400 E
Mailing Address - Street 2:
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-2916
Mailing Address - Country:US
Mailing Address - Phone:435-590-3451
Mailing Address - Fax:
Practice Address - Street 1:835 S 400 E
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-2916
Practice Address - Country:US
Practice Address - Phone:435-590-3451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7643664-6009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional