Provider Demographics
NPI:1750044277
Name:ROEPER, JOSHUA ELLIOT (LPC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ELLIOT
Last Name:ROEPER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 DENT BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:OROFINO
Mailing Address - State:ID
Mailing Address - Zip Code:83544-6003
Mailing Address - Country:US
Mailing Address - Phone:208-310-1170
Mailing Address - Fax:
Practice Address - Street 1:1706 G ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2021
Practice Address - Country:US
Practice Address - Phone:208-751-0478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-8248101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor