Provider Demographics
NPI:1275821498
Name:KING, JULIE ANN (MED, CRC, LPC)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANN
Last Name:KING
Suffix:
Gender:F
Credentials:MED, CRC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 E SELTICE WAY
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-5590
Mailing Address - Country:US
Mailing Address - Phone:208-771-0071
Mailing Address - Fax:
Practice Address - Street 1:3000 E SELTICE WAY
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-5590
Practice Address - Country:US
Practice Address - Phone:208-771-0071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID4724101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional