Individual
JULIE C ETZEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1169 EASTERN PKWY, SUITE 3357, LOUISVILLE, KY 40217-1417
(502) 454-0755
(502) 479-1231
Mailing address
1169 EASTERN PKWY, SUITE 2266, LOUISVILLE, KY 40217-1417
(502) 238-3178
(502) 238-3653
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1616
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
071-007127
IL STATE LIC
IL
01
—
1616
KY PSYCHOLOGY LICENSE
KY
Enumeration date
10/03/2006
Last updated
06/21/2011
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