Provider Demographics
NPI:1639215023
Name:JULIAN, SHAUNA (LCPC)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:JULIAN
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 1:2011 S RIDGE POINT WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-8516
Mailing Address - Country:US
Mailing Address - Phone:208-336-3607
Mailing Address - Fax:
Practice Address - Street 1:2011 S RIDGE POINT WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-8516
Practice Address - Country:US
Practice Address - Phone:208-336-3607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-369101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health