Provider Demographics
NPI:1619206588
Name:BARDSLEY, JULI A (LPC)
Entity Type:Individual
Prefix:
First Name:JULI
Middle Name:A
Last Name:BARDSLEY
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 1:3655 S JOHNS AVE
Mailing Address - Street 2:
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-9009
Mailing Address - Country:US
Mailing Address - Phone:208-365-1637
Mailing Address - Fax:
Practice Address - Street 1:501 N 16TH ST
Practice Address - Street 2:SUITE 108
Practice Address - City:PAYETTE
Practice Address - State:ID
Practice Address - Zip Code:83661-2781
Practice Address - Country:US
Practice Address - Phone:208-642-2600
Practice Address - Fax:208-642-6164
Is Sole Proprietor?:No
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806586200Medicaid