Provider Demographics
NPI:1629188537
Name:VANWINKLE, JOSEPH LEE (MS, LCPC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LEE
Last Name:VANWINKLE
Suffix:
Gender:M
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 PARKCENTRE WAY STE 4
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-1794
Mailing Address - Country:US
Mailing Address - Phone:208-467-2673
Mailing Address - Fax:208-467-4150
Practice Address - Street 1:847 PARKCENTRE WAY STE 4
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-1794
Practice Address - Country:US
Practice Address - Phone:208-467-2673
Practice Address - Fax:208-467-4150
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-3936101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010153423OtherREGENCE BLUE SHIELD OF ID