Provider Demographics
NPI:1043039571
Name:JOHNSON-MINNICK, JULY J (LCSW)
Entity type:Individual
Prefix:
First Name:JULY
Middle Name:J
Last Name:JOHNSON-MINNICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-6623
Mailing Address - Country:US
Mailing Address - Phone:903-266-3400
Mailing Address - Fax:903-566-0586
Practice Address - Street 1:4111 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-6623
Practice Address - Country:US
Practice Address - Phone:903-266-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-10
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX562741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical