Provider Demographics
NPI:1235210865
Name:JULIE B. SHIFFLER, PHD, PC
Entity Type:Organization
Organization Name:JULIE B. SHIFFLER, PHD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHIFFLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:208-201-6690
Mailing Address - Street 1:2404 N 3000 W
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-3126
Mailing Address - Country:US
Mailing Address - Phone:208-201-6690
Mailing Address - Fax:208-496-1238
Practice Address - Street 1:2404 N 3000 W
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-3126
Practice Address - Country:US
Practice Address - Phone:208-201-6690
Practice Address - Fax:208-496-1238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY-378103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty