Provider Demographics
NPI:1497081681
Name:ZIERKE, JUSTIN DEAN (LCPC, NCC, ACADC)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:DEAN
Last Name:ZIERKE
Suffix:
Gender:M
Credentials:LCPC, NCC, ACADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 HUMMINGBIRD CIR
Mailing Address - Street 2:
Mailing Address - City:SHELLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83274-5099
Mailing Address - Country:US
Mailing Address - Phone:208-821-1384
Mailing Address - Fax:208-478-4999
Practice Address - Street 1:1070 HILINE RD STE 210
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2947
Practice Address - Country:US
Practice Address - Phone:208-821-1384
Practice Address - Fax:208-478-4999
Is Sole Proprietor?:No
Enumeration Date:2009-10-23
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID160101YA0400X
ID205596101YA0400X
IDLCPC-4875101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1497081681Medicaid