Healthcare Provider Details

I. General information

NPI: 1619206588
Provider Name (Legal Business Name): JULI A BARDSLEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2009
Last Update Date: 12/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N 16TH ST SUITE 108
PAYETTE ID
83661-2781
US

IV. Provider business mailing address

3655 S JOHNS AVE
EMMETT ID
83617-9009
US

V. Phone/Fax

Practice location:
  • Phone: 208-642-2600
  • Fax: 208-642-6164
Mailing address:
  • Phone: 208-365-1637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: