Provider Demographics
NPI:1437369451
Name:VANDERPLOEG, JULIE C (LPC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:C
Last Name:VANDERPLOEG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:GREYBULL
Mailing Address - State:WY
Mailing Address - Zip Code:82426-0344
Mailing Address - Country:US
Mailing Address - Phone:307-250-0123
Mailing Address - Fax:844-389-3607
Practice Address - Street 1:1040 N 6TH ST
Practice Address - Street 2:
Practice Address - City:GREYBULL
Practice Address - State:WY
Practice Address - Zip Code:82426-1613
Practice Address - Country:US
Practice Address - Phone:307-250-0123
Practice Address - Fax:844-389-3607
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2016-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC-3522101YM0800X
WY1538101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1437369451Medicaid
CO18403786Medicaid