Provider Demographics
NPI:1881941631
Name:SEVERSON, JULIE (LCPC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:SEVERSON
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 1:428 W FALL DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-4822
Mailing Address - Country:US
Mailing Address - Phone:208-965-7600
Mailing Address - Fax:888-604-8113
Practice Address - Street 1:3350 W AMERICANA TER STE 210A
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-2521
Practice Address - Country:US
Practice Address - Phone:208-623-8530
Practice Address - Fax:888-604-8113
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-11
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID5010101Y00000X
IDLCPC-6151101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor