Provider Demographics
NPI:1346791241
Name:FREDERICK, JULIE (LCPC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1372 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-5701
Mailing Address - Country:US
Mailing Address - Phone:406-407-0815
Mailing Address - Fax:
Practice Address - Street 1:1372 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-5701
Practice Address - Country:US
Practice Address - Phone:406-407-0815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-19128101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health