Healthcare Provider Details

I. General information

NPI: 1215589296
Provider Name (Legal Business Name): JULIA LYN CDEBACA LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 CLEVELAND BLVD STE 205
CALDWELL ID
83605-4080
US

IV. Provider business mailing address

207 MOUNTAIN VIEW DR
NAMPA ID
83686-8867
US

V. Phone/Fax

Practice location:
  • Phone: 208-606-3001
  • Fax:
Mailing address:
  • Phone: 208-244-1298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: