Provider Demographics
NPI:1447378187
Name:SPENCER, JULIE WELWOOD (MED)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:WELWOOD
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MRS
Other - First Name:JULIE
Other - Middle Name:R
Other - Last Name:WELWOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED
Mailing Address - Street 1:500 BROOKS CT
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-9752
Mailing Address - Country:US
Mailing Address - Phone:972-740-3005
Mailing Address - Fax:972-647-1072
Practice Address - Street 1:500 BROOKS CT
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262-9752
Practice Address - Country:US
Practice Address - Phone:972-740-3005
Practice Address - Fax:972-647-1072
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9780101YP2500X
UT1062101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional