Provider Demographics
NPI:1477597011
Name:MYERS, JULIA ROSE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:ROSE
Last Name:MYERS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:2500 W KOOTENAI ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-2408
Mailing Address - Country:US
Mailing Address - Phone:208-908-0582
Mailing Address - Fax:208-908-0580
Practice Address - Street 1:2500 W KOOTENAI ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-2408
Practice Address - Country:US
Practice Address - Phone:208-908-0582
Practice Address - Fax:208-908-0580
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-3406101YM0800X, 101YP2500X
WALH00010983101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health