Provider Demographics
NPI:1790593036
Name:HUMMER, JULIA EDEN (LPC)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:EDEN
Last Name:HUMMER
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 1:1417 N 19TH ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-2534
Mailing Address - Country:US
Mailing Address - Phone:385-368-8243
Mailing Address - Fax:
Practice Address - Street 1:5999 W STATE ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:ID
Practice Address - Zip Code:83703-5059
Practice Address - Country:US
Practice Address - Phone:208-398-0043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2271342101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health