Provider Demographics
NPI:1730207002
Name:STATES, JULIA LYNN (LICENSED CLINICAL SO)
Entity type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:LYNN
Last Name:STATES
Suffix:
Gender:F
Credentials:LICENSED CLINICAL SO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3219 NORTH MAIN
Mailing Address - Street 2:PO BOX 485
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702
Mailing Address - Country:US
Mailing Address - Phone:606-487-8657
Mailing Address - Fax:606-439-0931
Practice Address - Street 1:3219 NORTH MAIN
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41702
Practice Address - Country:US
Practice Address - Phone:606-487-8657
Practice Address - Fax:606-439-0931
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY955104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
237158OtherMHN HMC
84421OtherMAGELLAN
000000043034OtherANTHEM BC BS
KY8200956Medicaid
000000043034OtherANTHEM BC BS