Provider Demographics
NPI:1871068213
Name:PRIVATE PRACTICE OF JULIE PRESENT KOLLER, PH.D., LLC
Entity type:Organization
Organization Name:PRIVATE PRACTICE OF JULIE PRESENT KOLLER, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESENT KOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:610-816-0031
Mailing Address - Street 1:1419 RYDAL RD
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-1216
Mailing Address - Country:US
Mailing Address - Phone:650-996-1757
Mailing Address - Fax:
Practice Address - Street 1:2043 LOCUST ST FL 1A
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-5662
Practice Address - Country:US
Practice Address - Phone:610-816-0031
Practice Address - Fax:215-600-3525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty