Provider Demographics
NPI:1275241077
Name:PETERS, JULIE M (LICSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:PETERS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5702 N DRISCOLL BLVD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-7628
Mailing Address - Country:US
Mailing Address - Phone:509-218-4299
Mailing Address - Fax:
Practice Address - Street 1:5702 N DRISCOLL BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-7628
Practice Address - Country:US
Practice Address - Phone:509-218-4299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA611452511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical